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ASA: Hydromorphone Analgesia Shorter Than That of Morphine but Side Effects Similar By Emma Hitt Special to DG News ORLANDO, FL -- October 17, 2002 -- Intrathecal hydromorphone given at one-fifth the dose of morphine has a shorter duration of analgesia, but side effects are similar, according to the findings of a randomized trial. Angelo B. Chiarella, MD, from the department of anesthesiology and pain medicine, University of Alberta Hospital, Edmonton, Canada, presented the research here October 16 at the 55th Annual Meeting of the American Society of Anesthesiologists (ASA). "A small study has suggested that one-fifth the dose of epidural hydromorphone may cause a lower incidence of pruritis than morphine," Dr. Chiarella told Doctor's Guide. "With our study, we wanted to compare these two agents head-to-head, which has never been done in a sufficiently powered study before." "We were anticipating that we would find a lower incidence of pruritis with hydromorphone, but actually all the side effects-pruritis, sedation, nausea, and vomiting--were similar between the two drugs," Dr. Chiarella said. The researchers compared intrathecal hydromorphone with morphine, in a 1- to 5-dose ratio for postoperative analgesia and side effects in 64 total knee- and 50 total hip-replacement patients (ASA 1-3). Participants were given spinal anesthesia with isobaric marcaine (3 milliliters 0.5%) plus either preservative-free hydromorphone (0.06 milligrams) or morphine (0.3 milligrams). Patient-controlled analgesia (PCA) with hydromorphone was started postoperatively in all patients with the onset of pain. Patients were assessed at 6 and 24 hours. They were asked to grade the severity of pain, itching, sedation, nausea and vomiting on a verbal analog scale (VAS) ranging from 0 to 10. Nausea was treated with dimenhydrinate first-line and metoclopramide second-line, and pruritis was treated with diphenhydramine. Seven patients were excluded; 3 for failed spinal anesthesia; 3 for PCA intolerance; and 1 for being a spinal analgesic outlier. Duration of effective spinal analgesia was longer with morphine in the hip group: 527 minutes versus 421 minutes (p=0.035) and approached significance in the knee group 453 minutes versus 385 minutes (p=0.059). Median pain scores and hydromorphone consumption did not differ significantly in the hip group. However, in the knee group, pain scores with movement at 6 hours were significantly higher with hydromorphone (p=0.027) as was PCA consumption by 6 hours (p=0.035) and 24 hours (p=0.001) hours. No differences were observed between the hydromorphone and morphine groups in the incidence of pain, side effects, or in the amount of antiemetic or antipruritic agents required. According to Dr. Chiarella, patients who are intolerant to morphine might benefit from taking hydromorphone instead, although the two drugs are structurally related, he pointed out. "We were hoping to find that hydromorphone would give a lower incidence of pruritis, but we didn’t find that," he said. "I still give morphine to my patients." E-mail this page to a friend or colleague! To print, use this version