title: Prolonged sinus pauses with hydromorphone in the absence of cardiac conduction disease.
abstract: A 49-year-old male had open sigmoid colectomy with colorectal anastomosis for sigmoid diverticulitis. The patient was given patient-controlled analgesia (PCA) hydromorphone and subsequently developed bradycardia with prolonged sinus pauses up to 7.1 seconds. The pauses resolved shortly after the hydromorphone was discontinued. This is the first case report to our knowledge of reversible prolonged sinus pauses associated with the use of hydromorphone. Animal studies support a role for opioid signaling at the sinoatrial (SA) node. Hydromorphone is a potential cause of prolonged sinus pauses and should be taken into consideration when monitoring a patient on hydromorphone for pain control.
authors.affiliation: Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina and Ralph H Johnson VA Medical Center, Charleston, SC 29425, USA. snarr@musc.edu
authors.forename: Brian S
authors.initials: BS
authors.lastname: Snarr
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Rowley
authors.forename: Stephanie V
authors.initials: SV
authors.lastname: Phan
authors.forename: Anand
authors.initials: A
authors.lastname: Achanti
authors.forename: Grady H
authors.initials: GH
authors.lastname: Hendrix
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D001919:Bradycardia / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D003082:Colectomy / Q000009:adverse effects; D004239:Diverticulitis, Colonic / Q000601:surgery; D006801:Humans; D004091:Hydromorphone / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D012849:Sinoatrial Node / Q000503:physiopathology*
chemical_list: D000701:Analgesics, Opioid; D004091:Hydromorphone