Protocolo de rotação de opioides

Abstract

This work presents a clinical protocol for opioid rotation in hospitalized patients, aiming to optimize pain management and minimize adverse effects. The main objective is to establish standardized and evidence-based guidelines for the safe and effective substitution of one opioid for another, considering the context of the Brazilian Unified Health System (SUS). The protocol was developed from a literature review on the pharmacology of available opioids, such as morphine, methadone, and tramadol, and is based on the principle of incomplete cross-tolerance. The inclusion and exclusion criteria for patients eligible for rotation, the responsibilities of the multidisciplinary team, and the necessary clinical assessment are detailed. The document provides a step-by-step algorithm for the rotation process, including the calculation of equianalgesic doses, with an emphasis on the non-linear conversion for methadone, the application of dose reduction for safety, and the prescription of rescue doses. Additionally, the protocol establishes rigorous parameters for post-rotation monitoring, criteria for dose adjustments, management of adverse events, and treatment discontinuation. It is concluded that the implementation of this protocol can improve the quality of analgesia, increase patient safety, reduce the incidence of intolerable side effects, and promote the rational use of opioids in the hospital setting.