Neuraxial opioids for post-cesarean delivery analgesia: can hydromorphone replace morphine? A retrospective study Hydromorphone and cesarean section

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 200 μg and 387 patients received intrathecal hydromorphone 60 μg. Eighty-one patients received epidural morphine 3 mg and 102 patients received epidural hydromorphone 0.6 mg. Results Median time to first opioid after intrathecal morphine was 17.0 h versus 14.6 h after intrathecal hydromorphone (P <0.0001). Patients who received intrathecal hydromorphone consumed more opioids in the first 24 h; 37.0 mg versus 26.4 mg 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 20.1 h versus 13.0 h 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.