Intrathecal Injection of Hydromorphone for Post-Cesarean Analgesia

Intrathecal Injection of Hydromorphone for Post-Cesarean Analgesia

Acta Medica Mediterranea, 2019, 35: 365 INTRATHECAL INJECTION OF HYDROMORPHONE FOR POST-CESAREAN ANALGESIA QIFEI LI1,#, FAN YANG2,#, KUN ZHANG3,#,WEI WANG1, SHANSHAN CAI4*, RUI XIA1** 1Department of Anesthesiology, The First People’s Hospital of Jinzhou, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, 434000, P. R. China - 2Department of Anesthesiology, First people’s Hospital of Yidu, Yidu, Hubei, 434000, P. R. China - 3Department of Anesthesiology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, 434000, P. R. China - 4Department of Cardiovascular, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei 430000, China #These authors contributed equally to this work ABSTRACT This study aimed to investigate clinical analgesia efficacy of intrathecal hydromorphone for women with cesarean section. 1,500 women with cesarean section and spinal anesthesia were chosen from May 2013 to October 2014 in four hospitals and randomly divided into two groups including control group (750 patients) with intrathecal sufentanil and observation group (750 patients) with intrathecal hydromorphone; and the pain scores at 4 h, 12 h and 24 h after cesarean, painless time and adverse events in both groups were compa- red. The pain scores at 12 h and 24 h after cesarean were significantly better in observation group than in control groups (P<0.05). The painless time was significantly longer in observation group than in control groups (P<0.05). There was no significant difference in adverse events between two groups (P>0.05). In conclusion, compared with intrathecal sufentanil intrathecal hydromorphone provides better analgesia efficacy for cesarean section and does not increase the risk of adverse events. Keywords: Intrathecal, hydromorphone, cesarean, anesthesia. DOI: 10.19193/0393-6384_2019_1_59 Received July 17, 2018; Accepted Septemper 20, 2018 Introduction This study aimed to investigate clinical analge- sia efficacy of intrathecal hydromorphone for women In recent years, intrathecal injection of opioid with cesarean section. We performed a multi-center for analgesia in obstetric operations has been widely control study to enroll cesarean section parturients applied(1). At present, sufentanil and other lipophilic who received sufentanil and hydromorphone by opioids are frequently used clinically and they are intrathecal injection. We compared pain scores, anal- fast in analgesia. However, the time of duration can gesia duration and occurrences of adverse reactions not sufficiently meet the need of anesthesia and there after operation. is obvious postoperation pain(2-3). Morphine is a kind of hydrophilic opioid with high affinity to opioid Patients and methods receptor and a long duration of analgesia, but is caus- es multiple adverse reactions. Therefore, how to find Clinical data an appropriate opioid for intrathecal injection for 1,500 caesarean section parturients with com- obstetric analgesia has become a concern of the anes- bined spinal-epidural anesthesia from May 2015 to thetists. Previous study showed that the hydromor- October 2016 from four hospitals were selected. All phone octanol/water distribution coefficient was 525 of them voluntarily participated in this study and and the lipid solubility was between sufentanil and signed the informed consent. This study was morphine(4). approved by the Ethics Committee of all four hospi- 366 Qifei Li, Fan Yang et Al tals. Exclusion criteria were: under 18 years old; time point for record (VAS less than 40 points was drug addiction history, chronic pain history and men- regarded as the time point for analgesia); Patients’ tal disease history; combined application of propofol adverse reactions such as nausea, vomiting, skin itch or ketamine during operation; the combination of and respiratory depression were observed. severe cardiopulmonary insufficiency, disturbances of blood coagulation and local infection of puncture Statistical analysis part. Selected parturients were divided into the con- SPSS15.0 was used for statistical analysis. The trol group and observation group with 750 parturi- measurement data were expressed as ±s and ana- ents in each group according to the random number lyzed by t-test. The data expressed as the percentage table method. The age of parturients in the control were analyzed by χ2 test. P<0.05 indicated signifi- group was 22-35 years old (average age 28.7±5.5 cant difference. years old) and the average BMI index was 34.7±6.0 kg/m2. The age of parturients in the observation Results group was 20-34 years old (average age 29.2±5.7 years old) and the average BMI index was 35.0±6.4 Comparison of pain scores of two groups at 4 kg/m2. h, 12 h and 24 h after operation The two groups of parturients had no signifi- Operation cance differences in age, BMI index and other clini- Venous channels were established for parturi- cal data before operation (P>0.05). There was no sig- ents before operation. Electrocardiograph monitoring nificance difference in pain score of parturients at 4 h was conducted for heart rate, blood pressure and after operation between observation group and con- breath. L2-3 arachnoid block inferior vena anesthesia trol group (P>0.05). However, pain scores of parturi- was selected. The parturients in the control group ents in observation group at 12 h and 24 h after oper- were intrathecally injected with 10 mg 0.5% bupiva- ation were significantly less than those of parturients caine + 5 μg sufentanil (Yichang Humanwell in control group (P<0.05, Table 1). Pharmaceutical Co., Ltd.; batch No. 2120313; speci- Number of Group 4h 12h 24h fication: 50 μg/ml); the parturients in the observation patients group were intrathecally injected with 10 mg 0.5% Control 750 11.9±1.7 24.9±3.3 40.0±5.7 bupivacaine + 100 μg hydromorphone (Yichang Observation 750 12.5±1.6 17.2±2.6* 22.5±3.0* Humanwell Pharmaceutical Co., Ltd.; batch No. t 1.241 1.996 2.269 20120100; specification: 1 mg/ml). The injection speeds of the two groups were consistent. After p 0.167 0.037 0.015 puncture success of subarachnoid space block anes- Table 1: Comparison of pain scores of two groups of thesia, the oxygen inhalation via nasal tube for 2-4 parturients at 4 h, 12 h and 24 h after operation. L/min was conducted. When the blood pressure was *Compared with the control group, p<0.05. less than 30% of basic value, 10 mg ephedrine was Comparison of analgesia duration of two intravenously injected. When the heart rate was less groups than 50 times/min, 0.5 mg atropine was intravenous- The analgesia duration of parturients in obser- ly injected. Neither of the two groups was given any vation group was significantly longer than that of composure, analgesia and other intravenous anesthe- control group (P<0.05, Table 2). sia drug assistances. All those with blocked anesthe- sia operation and uncertain effects were excluded. Group Number of patients Analgesia duration Control 750 28.0±3.9 Measurements Pain degree assessment was conducted respec- Observation 750 41.7±8.4* tively at 4 h, 12 h and 24 h after operation. The VAS t 2.478 was adopted. The total point is 100: 0 point refers to p 0.003 no pain; 1-30 points refer to mild pain; 31-60 point refers to moderate pain; 61-90 points refer to severe Table 2: Comparison of analgesia durations of two grou- pain; 91-100 points refer to sharp pain. Patients’ ps of parturients (h). *Compared with the control group, p<0.05. analgesia duration was recorded and the time when a patient dictated the pain perception was used as the Intrathecal injection of hydromorphone for post-cesarean analgesia 367 Comparison of adverse reactions of two less than that of control group, indicating that the groups postoperative analgesic effect of intrathecal injection The adverse reactions such as nausea, vomiting, of hydromorphone is superior to that of sufentanil. skin itch, and respiratory depression after operation However, the comparison of nausea, vomiting, skin showed no significant difference between observa- itch, respiratory depression and other adverse reac- tion group and control group (P>0.05, Table 3). tions between the two groups of parturients showed no significant difference. Number of Respiratory Group Nausea & vomiting Skin itch patients depression In conclusion, compared with sufentanil, intrathecal injection of hydromorphone for post- Control group 750 340(45.3) 70(9.3) 0(0.0) cesarean analgesia has a longer analgesia duration, is Observation group 750 350(46.7) 50(6.7) 0(0.0) safer, has a better analgesic effect, while does not increase the risk of adverse reactions. Therefore, it χ2 1.335 2.052 - can be used as an ideal choice for obstetric analgesia. p 0.118 0.086 0.254 Table 3: Comparison of adverse reactions between two groups of parturients. Discussion References In recent years, combined application of epidur- 1) Du PS, Du PA, Hillyer J. (2006) Intrathecal hydromor- al local anesthetic and lipophilic opioid in obstetric phone for intractable nonmalignant pain: a retrospective study. Pain Med. 7(1): 10-15. operations can effectively improve the quality of 2) Newsome S, Frawley BK, Argoff CE. (2008) Intrathecal spinal anesthesia, avoid nerve block and reduce analgesia for refractory cancer pain. Curr Pain Headache adverse reactions and other risks(5). At present, sufen- Rep. 12(4): 249-256. tanil is the most common lipophilic opioid, the onset 3) Niruthisard S, Werawataganon T, Bunburaphong P, time of sufentanil is fast (only 5-8 min) but its anal- Ussawanophakiat M, Wongsakornchaikul C, Toleb K. (2007) Anesth Analg. 105(3): 822-824. gesia duration is short (2-4 h). This is related to the 4) Rathmell JP, Lair TR, Nauman B.

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