ANALGESIA AFTER CESAREAN DELIVERY: A RETROSPECTIVE COMPARISON OF INTRATHECAL MORPHINE AND HYROMORPHONE
Abstract Number: T-23
Abstract Type: Original Research
Background: Intrathecal morphine (ITM) is used to provide postoperative analgesia for cesarean delivery but is associated with opiate-related side effects (1). Hydromorphone is used for continuous spinal analgesia in chronic pain states and may have fewer opiate-related side effects compared to morphine in this chronic pain patient population (2,3). There is limited evidence describing intrathecal hydromorphone’s (ITH) efficacy and side effects for acute postsurgical pain. This retrospective study compared the analgesic and opiate-related side effects of ITM and ITH after elective cesarean delivery.
Methods: All patients aged ≥ 18 years that underwent elective cesarean delivery from 2006 to 2010 under spinal anesthesia and received 0.04 mg ITH for postoperative analgesia were retrospectively identified. These patients were matched 1:2 with patients that received 0.1 mg ITM during the same time period. Records were reviewed for demographical information, verbal pain scores (4, 8, 12, 18, 24 hours) using a 10-point scale (0 = none, 10 = worst), 24-hour opiate consumption (oral morphine equivalents), and presence of opiate-related complications (pruritus, nausea, vomiting, sedation, respiratory depression) requiring treatment. Nonparametric quantitative variables were compared using Kruskall-Wallis statistic, and qualitative variables were compared using Chi-square statistic. Statistical significance was assumed at p<0.05.
Results: Thirty-eight patients were identified that received ITH 0.04 mg for elective cesarean delivery. These patients were matched to 76 patients that received 0.1 mg ITM. There were no significant demographical differences between groups. There were no significant differences between groups in the incidence of opiate-related complications, pain scores at any time point, or 24-hour opiate consumption (Table 1).
Conclusions: For patients undergoing elective cesarean delivery, the quality and duration of analgesia and incidence of opiate-related side effects after 0.04 mg ITH was not significantly different than 0.1 mg ITM. ITH 0.04 mg may be a reasonable analgesic alternative for patients undergoing elective cesarean delivery. Further research is needed to validate the role of ITH in postoperative analgesia.
References: 1) Craig P, et al. Anesthesiology 1999;90(2):437-44, 2) Newsome S, et al. Curr Pain Headache Rep 2008;12(4):249-56, 3) Murray A, et al. J Pain Symp Manage 2005;29(5S):S57-S66