Transitioning From Intrathecal Hydromorphone to Sublingual Buprenorphine–Naloxone Through Microdosing: A Case Report
A&A Practice September 21, 2020 Isaiah T. Crum, VaKara M. Meyer Karre, Alëna A. Balasanova
A 76-year-old woman with chronic noncancer pain and an intrathecal hydromorphone–bupivacaine pump was hospitalized for worsening heart failure. The pump could not be replaced, and oral opioids caused breathing problems. Tapering the intrathecal drug led to withdrawal. Microdosing sublingual buprenorphine–naloxone allowed safe discontinuation of intrathecal hydromorphone, providing adequate pain relief without withdrawal or respiratory depression. This approach had not been previously reported.