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Hydromorphone Versus Fentanyl-Based Induction of Anesthesia for Postoperative Pain and Emergence Delirium in Children

Qiyuan Huang1, Yongwei Su1, Xiaohui Sun2

  • 1Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Paediatric Anaesthesia
|July 10, 2025
PubMed

Insights

Hydromorphone may offer better pain relief and reduce emergence delirium in children after strabismus surgery compared to fentanyl. This study compared hydromorphone and fentanyl for anesthesia induction in pediatric patients undergoing eye surgery.

Area of Science:

  • Pediatric Anesthesiology
  • Pain Management
  • Ophthalmology Surgery

Background:

  • Anesthesia induction agents play a crucial role in perioperative pain management for pediatric patients.
  • Optimizing analgesia and minimizing emergence delirium are key goals in pediatric anesthesia.

Purpose of the Study:

  • To compare the efficacy of hydromorphone versus fentanyl for anesthesia induction in pediatric patients undergoing strabismus surgery.
  • To evaluate the impact on immediate postoperative pain and emergence delirium.

Main Methods:

  • Prospective, double-blind, randomized controlled trial involving 186 preschool children (3-7 years).
  • Patients received either hydromorphone (0.02 mg/kg) or fentanyl (3 μg/kg) for anesthesia induction.
  • Primary outcome: Face, Legs, Activity, Cry, and Consolability (FLACC) pain score at extubation. Secondary outcomes included emergence delirium incidence and other perioperative parameters.

Main Results:

  • Hydromorphone group exhibited significantly lower FLACC pain scores at extubation compared to the fentanyl group (p=0.014).
  • The incidence of emergence delirium was significantly lower in the hydromorphone group (75.3%) versus the fentanyl group (93.4%) (p=0.004).
  • Other secondary outcomes, including sedation scores and hemodynamic parameters, were comparable between groups.

Conclusions:

  • Hydromorphone administration during anesthesia induction may provide superior postoperative analgesia.
  • Hydromorphone appears to reduce the incidence of emergence delirium in pediatric patients after strabismus surgery.
  • This suggests hydromorphone as a potentially beneficial agent for anesthesia induction in this population.
Abstract

Keywords:
childrenfentanylhydromorphoneopioidsperioperative pain management

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