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
Summary
AI-generated from the abstractA 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.
Study at a glance
| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | Patient with chronic noncancer pain and intrathecal hydromorphone–bupivacaine pump |
| Key finding | 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.