Transitioning From Intrathecal Hydromorphone to Sublingual Buprenorphine–Naloxone Through Microdosing: A Case Report
Isaiah T. Crum, VaKara M. Meyer Karre, Alëna A. Balasanova
A&A Practice September 21, 2020 DOI: 10.1213/xaa.0000000000001316 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | Patient with chronic noncancer pain and intrathecal hydromorphone–bupivacaine pump |
| Intervention | Buprenorphine–naloxone |
| Topics | Microdosing |
| Key findings | Microdosing sublingual buprenorphine–naloxone successfully weaned a patient off intrathecal hydromorphone without opioid withdrawal or ventilatory depression. |
Abstract
A 76-year-old woman with chronic noncancer pain and an intrathecal hydromorphone–bupivacaine pump was admitted for acute exacerbation of heart failure. Her pump was unable to be replaced due to medical comorbidities. She was unable to tolerate oral opioids due to ventilatory depression. Tapering hydromorphone resulted in opioid withdrawal due to physiological dependence. Microdosing of sublingual buprenorphine–naloxone was initiated while decreasing intrathecal hydromorphone. This successfully weaned the patient off intrathecal hydromorphone with adequate pain relief and prevented both opioid withdrawal and ventilatory depression. To our knowledge, microdosing buprenorphine-naloxone to assist with discontinuing intrathecal opioids has not been previously reported in the literature.