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Morphine and hydromorphone epidural analgesia. A prospective, randomized comparison
S R Chaplan1, S R Duncan, J B Brodsky
1Department of Anesthesia, Stanford University School of Medicine, California.
Anesthesiology
|December 1, 1992
Summary
Epidural hydromorphone and morphine offer similar pain relief after surgery. However, hydromorphone significantly reduces itching (pruritus) compared to morphine, especially on the first postoperative day.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Previous studies suggested epidural hydromorphone may have fewer side effects than epidural morphine.
- A need existed to rigorously compare side effect profiles in a controlled setting.
Purpose of the Study:
- To compare the side effects of lumbar epidural morphine versus hydromorphone in non-obstetric surgical patients.
- To assess pain, sedation, nausea, and pruritus in a randomized, blinded study.
Main Methods:
- A randomized, blinded study involving 55 adult patients undergoing major surgery.
- Administered epidural morphine or hydromorphone via bolus and 2-day infusion, titrated to comfort.
- Assessed pain, sedation, nausea, and pruritus using Visual Analog Scales (VAS) twice daily.
Main Results:
- Both epidural morphine and hydromorphone provided equivalent analgesia.
- No significant differences were observed in sedation scores or nausea prevalence.
- Pruritus prevalence was significantly lower with hydromorphone (11.5%) versus morphine (44.4%) on postoperative day 1 (P < .01).
Conclusions:
- Lumbar epidural morphine and hydromorphone offer comparable postoperative analgesia.
- Epidural hydromorphone is associated with a reduced incidence of moderate to severe pruritus on the first postoperative day compared to morphine.