Efficacy and safety of scheduled dosing of opioid analgesics: A quality improvement study

Scheduled dosing of opioids is believed to provide more effective analgesia when compared to as needed (PRN) administration of the drug; however, few studies have evaluated the value of this approach. Therefore, a quality improvement study was conducted to determine the efficacy and safety of scheduled dosing of opioid analgesics, using a 2-group parallel design. One medical unit in a large urban academic medical center employed scheduled dosing, whereas a comparable unit used PRN dosing. The primary outcome indicators included pain intensity ratings and opioid doses, along with adverse events. Scheduled dosing was associated with decreased pain intensity ratings. There were no statistically significant differences in the amount of opioid ordered, or the amount administered when comparing scheduled vs. PRN dosing. However, when the amount of opioid given was expressed as a percentage of the amount ordered, the difference between scheduled (70.8%) and PRN (38%) dosing was statistically significant (P = .0001). There was no difference in adverse events between the 2 groups. These findings suggest that scheduled dosing of opioids in an inpatient medical population provides improved analgesia with no increased risk of adverse events. Perspective: Scheduled dosing of opioids in an inpatient medical population improves analgesia, theoretically by overcoming barriers to drug administration, as well as providing more stable plasma levels of the opioid. (c) 2005 by the American Pain Society.