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Hydromorphone Unit Dose Affects Intraoperative Dosing: An Observational Study.

Brent D Ershoff1, Tristan Grogan, Joe C Hong

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The unit dose of hydromorphone significantly impacts intraoperative administration. Changing from 2 mg to 1 mg unit doses decreased hydromorphone administration, while reintroducing 2 mg doses increased it.

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Area of Science:

  • Anesthesiology
  • Pharmacology
  • Health Services Research

Background:

  • Limited research exists on how drug formulation, specifically unit dose, influences intraoperative opioid administration.
  • Clinical factors are known, but the impact of hydromorphone's specific unit dose on administration quantity is understudied.

Purpose of the Study:

  • To investigate if the unit dose of hydromorphone independently determines the quantity administered during surgery.
  • To analyze the effect of switching between 1-mg and 2-mg hydromorphone unit doses on intraoperative administration patterns.

Main Methods:

  • An observational cohort study of 15,010 patients receiving intraoperative hydromorphone.
  • Utilized interrupted time series analysis with segmented Poisson regression to evaluate changes in administration around unit dose switches.
  • Data collected from February 2016 to March 2018 at UCLA hospitals, analyzing periods with 2-mg, 1-mg, and re-introduced 2-mg unit doses.

Main Results:

  • A switch from 2-mg to 1-mg hydromorphone unit doses correlated with a 49% relative decrease in administering doses >1 mg (RR, 0.51; P < 0.0001).
  • Reintroducing the 2-mg unit dose was associated with a 48% relative increase in administering doses >1 mg (RR, 1.48; P = 0.008).

Conclusions:

  • The unit dose of hydromorphone (1 mg vs. 2 mg) is a significant, independent factor influencing intraoperative administration quantities.
  • Changes in available hydromorphone unit doses directly alter the probability of administering higher dose amounts during surgical procedures.