TY - JOUR
T1 - Intrathecal Hydromorphone and Morphine for Postcesarean Delivery Analgesia
T2 - Determination of the ED 90 Using a Sequential Allocation Biased-Coin Method
AU - Sviggum, Hans P.
AU - Arendt, Katherine W.
AU - Jacob, Adam K.
AU - Niesen, Adam D.
AU - Johnson, Rebecca L.
AU - Schroeder, Darrell R.
AU - Tien, Michael
AU - Mantilla, Carlos B.
N1 - Publisher Copyright:
Copyright © 2016 International Anesthesia Research Society.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - BACKGROUND: Intrathecal (IT) morphine is considered the "gold standard" for analgesia after cesarean delivery under spinal anesthesia, most commonly administered at a dose of 100 to 200 μg. There is less experience with IT hydromorphone for postcesarean analgesia and limited information on its optimal analgesic dose. We conducted this study to determine the effective analgesic dose for 90% patients (ED 90) of IT hydromorphone that provides effective analgesia for women undergoing elective cesarean delivery and its potency ratio to IT morphine. METHODS: In this dose-finding trial, 80 patients received spinal anesthesia for cesarean delivery. Participants were randomized to receive IT morphine or IT hydromorphone at a dose determined using up-down sequential allocation with a biased-coin design to determine ED 90. All patients received standardized multimodal analgesia postoperatively in addition to IT opioid. An effective dose was defined as a numeric response score for pain of ≤3 (scale 0-10) 12 hours after spinal injection. RESULTS: The ED 90 was 75 μg (95% confidence interval [CI], 46-93 μg) for IT hydromorphone and 150 μg (95% CI, 145-185 μg) for IT morphine. At these doses, the 95% CI for the percentage of patients with effective analgesia (numeric rating scale ≤3) was 64% to 100% for hydromorphone and 68% to 100% for morphine. Exploratory findings showed that the incidence of nausea and pruritus was not different among the most commonly used doses of IT hydromorphone (P = 0.44 and P = 0.74) or IT morphine (P = 0.67 and P = 0.38, respectively). When administering IT opioids at ED 90 doses or higher, 100% (21/21) of IT hydromorphone and 95% (37/39) of IT morphine patients were satisfied with their analgesia. CONCLUSIONS: The ratio of IT morphine to IT hydromorphone for effective postcesarean analgesia is 2:1. Patient satisfaction was high with both medications.
AB - BACKGROUND: Intrathecal (IT) morphine is considered the "gold standard" for analgesia after cesarean delivery under spinal anesthesia, most commonly administered at a dose of 100 to 200 μg. There is less experience with IT hydromorphone for postcesarean analgesia and limited information on its optimal analgesic dose. We conducted this study to determine the effective analgesic dose for 90% patients (ED 90) of IT hydromorphone that provides effective analgesia for women undergoing elective cesarean delivery and its potency ratio to IT morphine. METHODS: In this dose-finding trial, 80 patients received spinal anesthesia for cesarean delivery. Participants were randomized to receive IT morphine or IT hydromorphone at a dose determined using up-down sequential allocation with a biased-coin design to determine ED 90. All patients received standardized multimodal analgesia postoperatively in addition to IT opioid. An effective dose was defined as a numeric response score for pain of ≤3 (scale 0-10) 12 hours after spinal injection. RESULTS: The ED 90 was 75 μg (95% confidence interval [CI], 46-93 μg) for IT hydromorphone and 150 μg (95% CI, 145-185 μg) for IT morphine. At these doses, the 95% CI for the percentage of patients with effective analgesia (numeric rating scale ≤3) was 64% to 100% for hydromorphone and 68% to 100% for morphine. Exploratory findings showed that the incidence of nausea and pruritus was not different among the most commonly used doses of IT hydromorphone (P = 0.44 and P = 0.74) or IT morphine (P = 0.67 and P = 0.38, respectively). When administering IT opioids at ED 90 doses or higher, 100% (21/21) of IT hydromorphone and 95% (37/39) of IT morphine patients were satisfied with their analgesia. CONCLUSIONS: The ratio of IT morphine to IT hydromorphone for effective postcesarean analgesia is 2:1. Patient satisfaction was high with both medications.
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U2 - 10.1213/ANE.0000000000001229
DO - 10.1213/ANE.0000000000001229
M3 - Article
C2 - 26974022
AN - SCOPUS:84961223632
SN - 0003-2999
VL - 123
SP - 691
EP - 697
JO - Anesthesia and analgesia
JF - Anesthesia and analgesia
IS - 3
ER -