Opioid equianalgesic conversion: the right dose

Ongoing diligent patient assessment is the most important step in the equianalgesic conversion process. The conversion must take into account individual patient characteristics such as age, renal function, side effects, and the patient's pain syndrome. In addition, if the opioid dose is not adequate to begin with, the conversion dose is less likely to be effective. In all situations, once the patient is converted, liberal titration and adjustment or individualized doses for each patient are required to ensure that the conversion transition is smooth and provides the patient with the analgesia needed to adequately manage the pain. Nurses play a major role in the assessment of patients receiving opioids for pain management. Inadequate pain management despite escalating doses, untoward side effects, loss of a route of administration, and sometimes cost and reimbursement issues necessitate an opioid conversion or rotation. Nurses also play a role in recommending the change and ensuring that patients receive the correct dose.