← Chapter 4
Medical-Surgical Nursing · Chapter 4

The Multimodal Analgesia Bench

Scheduled non-opioids cut opioid requirement by 30 to 50 percent, and therefore cut every opioid side effect proportionally. Pick a patient, build the plan order by order, and watch the acetaminophen total, the renal and gastric ceilings and the opioid traps light up as you go. Then switch to Rotate the opioid and do the cross-tolerance arithmetic that keeps a rotation from becoming an overdose.
Whose plan are you building?
Write the orders
Rotating from
Rotating to
Equianalgesic reference — the doses that are roughly equal
Morphine 10 mg IV = 30 mg PO · hydromorphone 1.5 mg IV = 7.5 mg PO · fentanyl 100 mcg IV · oxycodone 20 mg PO · hydrocodone 30 mg PO · codeine 200 mg PO. These tables vary between references and are estimates, not equivalences.
Pick a patient
Every analgesic plan starts with scheduled non-opioids.