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Intrathecal Hydromorphone vs. Intrathecal Morphine: A study comparing efficacy, side-effect profiles and optimum dose of hydromorphone
Abstract Number: F-26
Abstract Type: Original Research
Recent shortage of preservative free morphine forced anesthesiologists to use Hydromorphone as an alternative to provide comparable post-operative analgesia for cesarean section. This is the first prospective study to compare the efficacy and side effect profiles between intrathecal (IT) morphine and intrathecal hydromorphone and to determine the optimum dose of IT hydromorphone.
Method and Study Design
It is a prospective randomized double blinded study. After IRB approval and written informed consent, parturients scheduled for elective cesarean section under spinal anesthesia are randomly assigned as per protocol to receive IT hydromorphone 40 mcg (Group A), 60 mcg (Group B), or IT morphine 100 mcg (Group C) along with 12 mg of hyperbaric bupivacaine. Time of first opiate usage, postoperative opiate consumption, pain scores by VAS at 0,6,12 and 24hrs and the patient’s satisfaction score, incidence of pruritus, nausea, vomiting, sedation and respiratory depression were collected. 42 participants (out of 105) had been enrolled so far.
Preliminary statistical analysis using ANOVA for all three groups showed that both 40mcg and 60 mcg of IT hydromorphone is similar in efficacy compared to 100 mcg of IT morphine (Figure). Comparison of PCA morphine consumption between the groups was similar. However, the median consumption of PCA morphine in Group A (12.8 mg) and B (9.9 mg) was less than Group C (16.4 mg). Comparison of post-op pain scores (VAS) and patient satisfaction scores were similar between the three groups. None of the participants reported respiratory depression, hypoxemia, or decrease in sedation score. The other side effects like nausea, vomiting, urinary retention are similar in all groups, except itching, which is slightly more in group B recipients (0.4 vs 0.92 vs 0.38; p = 0.010). With continued patient enrollment, we hope to refine our analyses with greater statistical power.
This preliminary results showed IT hydromorphone in 40 mcg or 60 mcg has similar analgesic effect and is a safe alternative to IT morphine 100 mcg for post-operative analgesia for cesarean section.