Comparison between sufentanil and hydromorphone for postoperative analgesia after cesarean section: a...

Cesarean delivery often causes significant postoperative pain, which can affect recovery and increase the risk of chronic pain and prolonged opioid use. This study compared commonly used hydromorphone and sufentanil regarding postoperative outcomes after cesarean delivery.

This multi-center retrospective cohort study, conducted across multiple centers in China between June 2022 and June 2025, included patients undergoing elective cesarean sections who received patient-controlled analgesia (PCA) with either hydromorphone or sufentanil. Postoperative pain, measured by the numerical rating scale (NRS), was the primary outcome. Secondary outcomes included use of rescue opioid use, incidence of postoperative nausea and vomiting (PONV), and hospitalization costs. Propensity score matching (PSM) was used to balance baseline characteristics, and regression models were applied to compare primary and secondary outcomes between groups.

Among 10,608 eligible patients, PSM yielded 2,682 matched pairs with good covariate balance. After matching, median NRS scores on day 1 were 4 [3-5] in sufentanil group, 4 [4-5] in hydromorphone group; on day 3, the score was 3 [2-3] in both groups. Matched pair-aware analyses showed no significant between-group differences in pain (day 1 mean difference 0.002, 95% CI -0.056 to 0.060, P = 0.945; day 3 mean difference 0.001, 95% CI -0.047 to 0.049, P = 0.960). Observed PONV was lower with sufentanil (4.88% vs. 7.38%, P < 0.001), but this was not statistically significant in matched pair-aware analysis (OR 0.815, 95% CI 0.235-2.830, P = 0.747). Rescue opioid use also did not differ significantly (OR 0.564, 95% CI 0.081-3.932, P = 0.563). Costs (in Renminbi) were lower with sufentanil in matched analyses: total cost mean difference -125.481 (95% CI -193.189 to -57.773), anesthesia cost -82.107 (95% CI -86.245 to -77.969), and PCA cost -82.218 (95% CI -85.298 to -79.138), all P < 0.001.

Hydromorphone and sufentanil provided comparable postoperative analgesia after elective cesarean section. Sufentanil was associated with lower analgesia-related and total costs, while differences in PONV and rescue opioid use were not statistically significant in matched pair-aware analyses.