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INTRATHECAL HYDROMORPHONE FOR POSTOPERATIVE ANALGESIA IN GYNECOLOGIC SURGERY

Department of Anesthesia, University of Manitoba, Winnipeg, Manitoba, Canada.

INTRODUCTION

Morphine was the first opioid used intrathecally for pain relief purposes.¹ It is now held as the "gold standard" for pain relief in the post-operative setting. An alternative to morphine is lacking, however hydromorphone has been suggested for this role.² We designed a study to determine the dose of hydromorphone that would be acceptable as an alternative to morphine for pain relief after gynecologic surgery.

METHODS

With ethics approval obtained, suitable participants were randomized in a double blind fashion to six groups and received one of the following, along with spinal bupivicaine anesthesia: hydromorphone (HM) 100,200,300,400 or 500 µg versus morphine (M) 100 µg. Outcomes measured were adequacy of analgesia as well as the severity of side effects. Time to first analgesic request was recorded along with morphine consumption. Treatment of side effects was also noted.

RESULTS

Data were collected for 142 patients. VAS scores for pain at rest and with movement were 2 and 3.5 respectively throughout the first 24 hours. A significant portion of the morphine group however requested analgesia earlier (p<.003) (Figure) and used more morphine iv (p=.003). There was no difference in quality of analgesia or the quantity of additional morphine iv used amongst the hydromorphone groups. The incidence of side effects was not significantly different amongst all the groups, however there was less diphenhydramine used in the morphine group.

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Excellent postoperative pain relief was achieved in all groups. However the morphine group required significantly more analgesia iv. The side effect profile was not significantly different in all groups. We therefore conclude that hydromorphone 100 µg offers superior analgesia when compared to morphine 100 µg. There was also no benefit in increasing the dose of hydromorphone above 100 µg. Future study should seek to determine the efficacy of a smaller dose of hydromorphone as well the effects in other patient groups.

REFERENCES

1 Anesthesiology 1979; 50:149–51.[Medline]

2 Seminars in Anesthesia, Perioperative Medicine and Pain (June) 19(2): 108-31, 2000.

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