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Intrathecal morphine compared to intrathecal hydromorphone for post-cesarean analgesia: a double-blind prospective randomized controlled trial
Abstract Number: GM-3
Abstract Type: Original Research
Background: Intrathecal opioids are routinely administered with local anesthetics during spinal anesthesia for analgesia after cesarean delivery. The effectiveness of intrathecal morphine (ITM) for post-cesarean analgesia is well-established (1-2), and the use of intrathecal hydromorphone (ITH) is growing. We previously determined the ED90 of ITM and ITH to be 150 mcg and 75 mcg, respectively (3). No prospective studies have directly compared the efficacy and side effects of ITM versus ITH for post-cesarean analgesia.
Methods: In this single center, double-blinded, randomized controlled trial, 134 parturients undergoing elective cesarean delivery were randomized to either 150 mcg of ITM or 75 mcg of ITH as part of their spinal anesthetic. A standardized multimodal analgesic regimen was administered to patients postoperatively, including scheduled acetaminophen and non-steroidal anti-inflammatory drugs, along with oral opioids on an as-needed basis. Pain scores, presence and severity of nausea and pruritus, degree of sedation, and patient satisfaction with analgesia were assessed every six hours for the first 36 hours postpartum. Total opioid consumption, medical treatment for nausea or pruritus, hospital length of stay, adverse events, and demographic information were recorded.
Results: Sixty-eight patients were randomized to receive ITM and 66 received ITH; demographics of the two groups were not significantly different. There was no significant difference in pain scores with movement at any time point between the two groups (Figure 1). There was no significant difference between the presence or severity of nausea or pruritus in the first 24 hours (p=0.590 and p=0.971, respectively), opioid use in the first 24 hours (p=0.334), or patient satisfaction (p=0.338) between the two groups. There were no adverse events in either group.
Conclusions: At ED90 doses, both ITM and ITH provide effective post-cesarean analgesia when combined with a multimodal analgesia regimen. Although there appears to be a trend towards lower pain with movement with ITM after 12 hours, this was not statistically significant. Given drug shortages of ITM across the country, this data suggests that ITH may be a reasonable substitute, as it likely provides clinically equivalent analgesia with a similar side effect profile.
1)Palmer CM et al. Anesthesiology 1999;90;437-44.
2)Dahl JB et al. Anesthesiology 1999;91;1919-27.
3)Sviggum HP et al. Anesth Analg 2016;123:690-7.