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Neuraxial opioids for post-cesarean delivery analgesia: can hydromorphone replace morphine? A retrospective study.
Int J Obstet Anesth. 2017 May; 30:16-22.IJ

Abstract

BACKGROUND

Cesarean delivery is the most common surgical procedure performed in the USA. We evaluated the postoperative analgesic properties of neuraxial hydromorphone compared to neuraxial morphine for post-cesarean delivery analgesia.

METHODS

A retrospective chart review was performed of women who underwent cesarean delivery and received neuraxial anesthesia from March to November 2011 and from March to November 2012. A total of 450 patients received intrathecal morphine 200μg and 387 patients received intrathecal hydromorphone 60μg. Eighty-one patients received epidural morphine 3mg and 102 patients received epidural hydromorphone 0.6mg.

RESULTS

Median time to first opioid after intrathecal morphine was 17.0h versus 14.6h after intrathecal hydromorphone (P<0.0001). Patients who received intrathecal hydromorphone consumed more opioids in the first 24h; 37.0mg versus 26.4mg oral morphine equivalents (P<0.001). The side effect profile between the intrathecal groups was similar. Median time to first opioid with epidural morphine was 20.1h versus 13.0h with epidural hydromorphone (P=0.0007). Total opioid consumption was not significantly different between the epidural groups. The side effect profiles were similar.

CONCLUSIONS

Hydromorphone is a reasonable alternative to morphine for post-cesarean delivery analgesia. With the dosing used in our study, analgesia from morphine lasted longer than hydromorphone via intrathecal and epidural routes; however, neuraxial hydromorphone remains a reasonable option for long-acting analgesia post cesarean delivery.

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Authors+Show Affiliations

Marroquin B
Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA. Electronic address: bridget.marroquin@uvmhealth.org.
Feng C
Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA.
Balofsky A
Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA.
Edwards K
Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA.
Iqbal A
Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA.
Kanel J
Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA.
Jackson M
University of Rochester College of Medicine, Rochester, NY, USA.
Newton M
University of Rochester College of Medicine, Rochester, NY, USA.
Rothstein D
Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA.
Wong E
Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA.
Wissler R
Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA.

MeSH

AdultAnalgesia, EpiduralAnalgesics, OpioidCesarean SectionFemaleHumansHydromorphoneInjections, SpinalMorphinePain, PostoperativePregnancyRetrospective StudiesTreatment OutcomeYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28185794

Clinical Trial Links

Epidural Morphine for Postoperative Analgesia After Total Knee Arthroplasty

Citation

Marroquin, B, et al. "Neuraxial Opioids for Post-cesarean Delivery Analgesia: Can Hydromorphone Replace Morphine? a Retrospective Study." International Journal of Obstetric Anesthesia, vol. 30, 2017, pp. 16-22.
Marroquin B, Feng C, Balofsky A, et al. Neuraxial opioids for post-cesarean delivery analgesia: can hydromorphone replace morphine? A retrospective study. Int J Obstet Anesth. 2017;30:16-22.
Marroquin, B., Feng, C., Balofsky, A., Edwards, K., Iqbal, A., Kanel, J., Jackson, M., Newton, M., Rothstein, D., Wong, E., & Wissler, R. (2017). Neuraxial opioids for post-cesarean delivery analgesia: can hydromorphone replace morphine? A retrospective study. International Journal of Obstetric Anesthesia, 30, 16-22. https://doi.org/10.1016/j.ijoa.2016.12.008
Marroquin B, et al. Neuraxial Opioids for Post-cesarean Delivery Analgesia: Can Hydromorphone Replace Morphine? a Retrospective Study. Int J Obstet Anesth. 2017;30:16-22. PubMed PMID: 28185794.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neuraxial opioids for post-cesarean delivery analgesia: can hydromorphone replace morphine? A retrospective study. AU - Marroquin,B, AU - Feng,C, AU - Balofsky,A, AU - Edwards,K, AU - Iqbal,A, AU - Kanel,J, AU - Jackson,M, AU - Newton,M, AU - Rothstein,D, AU - Wong,E, AU - Wissler,R, Y1 - 2016/12/30/ PY - 2016/09/12/received PY - 2016/12/02/revised PY - 2016/12/26/accepted PY - 2017/2/12/pubmed PY - 2018/3/9/medline PY - 2017/2/11/entrez KW - Analgesia KW - Cesarean section KW - Hydromorphone KW - Morphine KW - Neuraxial SP - 16 EP - 22 JF - International journal of obstetric anesthesia JO - Int J Obstet Anesth VL - 30 N2 - BACKGROUND: Cesarean delivery is the most common surgical procedure performed in the USA. We evaluated the postoperative analgesic properties of neuraxial hydromorphone compared to neuraxial morphine for post-cesarean delivery analgesia. METHODS: A retrospective chart review was performed of women who underwent cesarean delivery and received neuraxial anesthesia from March to November 2011 and from March to November 2012. A total of 450 patients received intrathecal morphine 200μg and 387 patients received intrathecal hydromorphone 60μg. Eighty-one patients received epidural morphine 3mg and 102 patients received epidural hydromorphone 0.6mg. RESULTS: Median time to first opioid after intrathecal morphine was 17.0h versus 14.6h after intrathecal hydromorphone (P<0.0001). Patients who received intrathecal hydromorphone consumed more opioids in the first 24h; 37.0mg versus 26.4mg oral morphine equivalents (P<0.001). The side effect profile between the intrathecal groups was similar. Median time to first opioid with epidural morphine was 20.1h versus 13.0h with epidural hydromorphone (P=0.0007). Total opioid consumption was not significantly different between the epidural groups. The side effect profiles were similar. CONCLUSIONS: Hydromorphone is a reasonable alternative to morphine for post-cesarean delivery analgesia. With the dosing used in our study, analgesia from morphine lasted longer than hydromorphone via intrathecal and epidural routes; however, neuraxial hydromorphone remains a reasonable option for long-acting analgesia post cesarean delivery. SN - 1532-3374 UR - https://www.unboundmedicine.com/medline/citation/28185794/Neuraxial_opioids_for_post_cesarean_delivery_analgesia:_can_hydromorphone_replace_morphine_A_retrospective_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0959-289X(16)30219-9 DB - PRIME DP - Unbound Medicine ER -