Opioid tapering in hematopoietic progenitor cell transplant recipients.
OBJECTIVE
To describe current opioid-tapering practice, patient pain levels and withdrawal symptoms, and nurse documentation during opioid tapers.


METHODS
Descriptive, exploratory, prospective, quantitative, and qualitative.


METHODS
A 32-bed blood and marrow transplant unit in a large, tertiary U.S. care center.


METHODS
45 blood and marrow transplant recipients between the ages of 7-64. Types of transplant were autologous, allogeneic, and unrelated donor marrow; peripheral blood stem cell; and umbilical cord blood.


METHODS
In daily interviews, patients reported pain levels and withdrawal symptoms during opioid tapers. Demographic, medication, and nurse documentation data were obtained from patient hospital records.


METHODS
Taper length, daily opioid dosage, pain, withdrawal symptoms, and nurse documentation.


RESULTS
Length of taper ranged from 1-17 days (X = 6.53, SD = 4.26). Analysis of variance indicated no difference by disease or transplant type in length of taper, cumulative opioids given pretaper or during taper, or number of self-reports of withdrawal symptoms. Daily changes in nurse-administered opioid dosage during tapers ranged from a decrease of 67% to an increase of 14%. Children received significantly more opioids/kg during taper than adults. Means of adults' and children's self-reports of pain were low. The means of patient-reported withdrawal symptoms were highest on taper days two through six. Nurse documentation was sparse.


CONCLUSIONS
Daily taper rates vary widely, pain is well managed, and most patients experience several withdrawal symptoms.


CONCLUSIONS
Use of an opioid-taper guideline may promote consistency of tapering while not increasing levels of pain or withdrawal symptoms.
Pederson
C
C
School of Nursing, University of Minnesota, Minneapolis, USA. peder001@tc.umn.edu
Parran
L
L
D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000704:Analysis of Variance; D002648:Child; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000451:nursing* / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000451:nursing; D010147:Pain Measurement / Q000379:methods / Q000451:nursing / Q000706:statistics & numerical data; D011446:Prospective Studies; D013375:Substance Withdrawal Syndrome / Q000451:nursing; D013997:Time Factors
D000701:Analgesics, Opioid