“STD” Orthodose versus “EBM” Orthodose
There are two versions of the Orthodose calculator of morphine rescue doses:
A standard “STD”version, and an “EBM” version that takes into account Evidence Based Medicine recommendations.
In the STD version, conversion ratios between the various opioids reflect the international recommendations of the pharmaceutical industry.
In the EBM version, the recommendations for relative opioid analgesic potencies that are marked as “Strong” by the European Association for Palliative Care* have been included. Of the two “weak” recommendations, one was accepted as is. As regards the other recommendation which concerns Hydromorphone, Orthodose has chosen a ratio between said recommendation and that of the pharmaceutical industry.
In addition, the EBM version provides for the continued use of subcutaneous and intravenous fentanyl and its derivatives. In several publications, this use is proposed for the relief of cancer pain, specifically in patients with renal failure.* This concerns off-label use.
*Use of Opioid Analgesics in the Treatment of Cancer Pain: Evidence-based
Recommendations from the EAPC(Lancet Oncol 2012; 13: e58-e68)