title: Neuraxial opioids for post-cesarean delivery analgesia: can hydromorphone replace morphine? A retrospective study.
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 200μg and 387 patients received intrathecal hydromorphone 60μg. Eighty-one patients received epidural morphine 3mg and 102 patients received epidural hydromorphone 0.6mg.
  
  
  RESULTS
  Median time to first opioid after intrathecal morphine was 17.0h versus 14.6h after intrathecal hydromorphone (P<0.0001). Patients who received intrathecal hydromorphone consumed more opioids in the first 24h; 37.0mg versus 26.4mg 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 20.1h versus 13.0h 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.
authors.affiliation: Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA. Electronic address: bridget.marroquin@uvmhealth.org.
authors.forename: B
authors.initials: B
authors.lastname: Marroquin
authors.affiliation: Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: C
authors.initials: C
authors.lastname: Feng
authors.affiliation: Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: A
authors.initials: A
authors.lastname: Balofsky
authors.affiliation: Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: K
authors.initials: K
authors.lastname: Edwards
authors.affiliation: Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: A
authors.initials: A
authors.lastname: Iqbal
authors.affiliation: Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: J
authors.initials: J
authors.lastname: Kanel
authors.affiliation: University of Rochester College of Medicine, Rochester, NY, USA.
authors.forename: M
authors.initials: M
authors.lastname: Jackson
authors.affiliation: University of Rochester College of Medicine, Rochester, NY, USA.
authors.forename: M
authors.initials: M
authors.lastname: Newton
authors.affiliation: Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: D
authors.initials: D
authors.lastname: Rothstein
authors.affiliation: Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: E
authors.initials: E
authors.lastname: Wong
authors.affiliation: Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: R
authors.initials: R
authors.lastname: Wissler
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D007278:Injections, Spinal; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000188:drug therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D004091:Hydromorphone
keywords: Analgesia; Cesarean section; Hydromorphone; Morphine; Neuraxial