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Updated: Nov 21, 2025
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Assessment of Morphine-induced Hyperalgesia and Analgesic Tolerance in Mice Using Thermal and Mechanical Nociceptive Modalities
Published on: July 29, 2014
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Morphine or hydromorphone: which should be preferred? A systematic review
Sarah Spénard1,2, Charles Gélinas3, Evelyne D Trottier4
1Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
Archives of Disease in Childhood
|January 19, 2021
Summary
This review compares morphine (Mo) and hydromorphone (Hm) in children. A 5:1 intravenous ratio appears effective with similar side effects, but more research is needed for optimal pediatric pain management.
Area of Science:
- Pediatric pharmacology
- Pain management
- Evidence-based medicine
Background:
- Morphine (Mo) and hydromorphone (Hm) are commonly used analgesics in pediatric care.
- Limited comparative data exists for their rational use in children.
Purpose of the Study:
- To systematically review and compare the efficacy and side effects of morphine (Mo) versus hydromorphone (Hm) in pediatric patients.
- To identify evidence-based conversion ratios for Mo to Hm across different administration routes.
Main Methods:
- Systematic review of four databases (1963-2019) including all pediatric studies comparing Mo and Hm.
- Analysis of 24 studies focusing on pharmacodynamics, adverse effects, and conversion ratios.
Main Results:
- Poor methodological quality was noted in most studies.
- An intravenous equianalgesic ratio of 5:1 for Mo to Hm showed similar efficacy and adverse effects (pruritus, nausea).
- Epidural administration with a 10:1 ratio suggested more adverse effects with Mo.
Conclusions:
- Current literature is insufficient for a definitive rational choice between Mo and Hm in pediatrics.
- A 5:1 intravenous ratio is suggested as adequate, with similar adverse event profiles.
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