Intrathecal Morphine versus Intrathecal Hydromorphone for Analgesia after Cesarean Delivery

Abstract

Background Intrathecal opioids are routinely administered during spinal anesthesia for postcesarean analgesia. The effectiveness of intrathecal morphine for postcesarean analgesia is well established, and the use of intrathecal hydromorphone is growing. No prospective studies have compared the effectiveness of equipotent doses of intrathecal morphine versus intrathecal hydromorphone as part of a multimodal analgesic regimen for postcesarean analgesia. The authors hypothesized that intrathecal morphine would result in superior analgesia compared with intrathecal hydromorphone 24 h after delivery. Methods In this single-center, double-blinded, randomized trial, 138 parturients undergoing scheduled cesarean delivery were randomized to receive 150 µg of intrathecal morphine or 75 µg of intrathecal hydromorphone as part of a primary spinal anesthetic and multimodal analgesic regimen; 134 parturients were included in the analysis. The primary outcome was the numerical rating scale score for pain with movement 24 h after delivery. Static and dynamic pain scores, nausea, pruritus, degree of sedation, and patient satisfaction were assessed every 6 h for 36 h postpartum. Total opioid consumption was recorded. Results There was no significant difference in pain scores with movement at 24 h (intrathecal hydromorphone median [25th, 75th] 4 [3, 5] and intrathecal morphine 3 [2, 4.5]) or at any time point (estimated difference, 0.5; 95% CI, 0 to 1; P = 0.139). Opioid received in the first 24 h did not differ between groups (median [25th, 75th] oral morphine milligram equivalents for intrathecal hydromorphone 30 [7.5, 45.06] vs. intrathecal morphine 22.5 [14.0, 37.5], P = 0.769). From Kaplan–Meier analysis, the median time to first opioid request was 5.4 h for hydromorphone and 12.1 h for morphine (log-rank test P = 0.200). Conclusions Although the hypothesis was that intrathecal morphine would provide superior analgesia to intrathecal hydromorphone, the results did not confirm this. At the doses studied, both intrathecal morphine and intrathecal hydromorphone provide effective postcesarean analgesia when combined with a multimodal analgesia regimen. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Clinical Study of Preemptive Analgesia with Hydromorphine on Postoperative Analgesia in Patients with Laparoscopic Hysterectomy

“…In the study of 80 patients undergoing laparoscopic gynecological surgery, Zhang [17] also found that intravenous injection of hydromorphine hydrochloride into 15 min before the end of the operation, did not prolong the extubation time and did not increase the incidence of postoperative respiratory depression, which supported the results of this study.…”

Neuraxial anesthesia and pain control for pediatric burn patients receiving excision and split‐thickness skin grafts—A retrospective case series

“…11 Intrathecal hydromorphone has previously been described in adults with similar efficacy and safety. 12 We reported pain score trends looking specifically at single-shot Of note, although the majority of our patient population had STSG from below the waist where the spinal local anesthetic could provide analgesic coverage, approximately one third had donor skin taken above the umbilicus, which would not be covered. Thus, it appears that the addition of an intrathecal opioid to the single-shot spinal provides effective analgesia for donor sites not covered by the local anesthetic.…”

Full Opioid Agonists and Tramadol: Pharmacological and Clinical Considerations

“…The study showed no difference in the analgesia produced by hydromorphone and that of morphine. Although hydromorphone also carries significant addiction potential, the result confounded researchers' expectation that morphine would produce better anesthesia (66). Although it does not directly compare morphine to a non-opioid drug, this study is likely to invite further inquiries testing long-held assumptions about the applications of opioids to surgical pain.…”