title: Hydromorphone vs fentanyl for epidural analgesia and anesthesia.
abstract: BACKGROUND
  Epidural analgesia/anesthesia is used during surgery because it dramatically relieves pain and attenuates the stress response. Because limited data exist regarding the relative merits of hydromorphone (HM) and fentanyl (FENT), the objective was to determine which was more safe and effective.
  
  
  METHODS
  Prospective case-matched, observational study evaluated elective surgery patients: 30 HM and 60 FENT. Variables were measured perioperatively.
  
  
  RESULTS
  Of the 90 patients, mean age was 52 years; simplified acute physiology score was 26 ± 10; and American Society of Anesthesiologists score was 2.4 HM vs 2.7 FENT, P = .03. HM patients were more apt to be excessively sedated (16% HM vs 1% FENT, P = .007) and have poor mental unresponsiveness (6% HM vs 0% FENT, P = .04). The incidence of hypotension was not different, 76% HM vs 80% FENT, not significant.
  
  
  CONCLUSIONS
  In a closely case-matched population, FENT caused less excessive sedation and unresponsiveness. FENT patients had better intraoperative urine output and tended to have less repeated episodes of hypotension.
authors.affiliation: Department of Pharmacy Services, Detroit Receiving Hospital, 4201 St. Antoine Blvd, UHC-1B, Detroit, MI 48201, USA.
authors.forename: Melissa N
authors.initials: MN
authors.lastname: Nguyen
authors.affiliation: Department of Pharmacy Services, Detroit Receiving Hospital, 4201 St. Antoine Blvd, UHC-1B, Detroit, MI 48201, USA. Electronic address: lisahallzimmerman@gmail.com.
authors.forename: Lisa Hall
authors.initials: LH
authors.lastname: Zimmerman
authors.affiliation: Department of Anesthesia, Harper University Hospital/Hutzel Women's Hospital, Detroit, MI, USA.
authors.forename: Kathy
authors.initials: K
authors.lastname: Meloche
authors.affiliation: Department of Surgery, Wayne State University/Detroit Receiving Hospital, Detroit, MI, USA.
authors.forename: Heather S
authors.initials: HS
authors.lastname: Dolman
authors.affiliation: Department of Surgery, Wayne State University/Detroit Receiving Hospital, Detroit, MI, USA.
authors.forename: Alfred E
authors.initials: AE
authors.lastname: Baylor
authors.affiliation: Department of Anesthesiology, Detroit Medical Center, Harper University Hospital, Detroit, MI, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Fuleihan
authors.affiliation: Department of Surgery, Wayne State University/Detroit Receiving Hospital, Detroit, MI, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Wilson
authors.affiliation: Department of Surgery, Wayne State University/Detroit Receiving Hospital, Detroit, MI, USA.
authors.forename: James G
authors.initials: JG
authors.lastname: Tyburski
mesh_terms: D018806:APACHE; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000758:Anesthesia / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D006801:Humans; D004091:Hydromorphone / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement; D011446:Prospective Studies; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D004091:Hydromorphone; D005283:Fentanyl
keywords: Analgesia; Anesthesia; Epidural; Fentanyl; Hydromorphone