Hydromorphone versus morphine: a historical cohort study to evaluate the quality of postoperative analgesia
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REPORTS OF ORIGINAL INVESTIGATIONS
Hydromorphone versus morphine: a historical cohort study to evaluate the quality of postoperative analgesia Comparaison de l’hydromorphone a` la morphine : une e´tude de cohorte historique pour e´valuer la qualite´ de l’analge´sie postope´ratoire . David Shin, BHSc . Matthew Conway, MD, FRCPC . Shannon Rodrigues, MD . Stefanie Smulski, MD Emily Trenker, MD, FRCPC . Harsha Shanthanna, MD, FRCPC . Thuva Vanniyasingam, PhD . Lehana Thabane, PhD . James Paul, MD, MSc, FRCPC Received: 7 May 2020 / Revised: 7 August 2020 / Accepted: 16 August 2020 Canadian Anesthesiologists’ Society 2020
Abstract Purpose Opioids are the most widely used therapy for pain during the postoperative period. It has been suggested by some that hydromorphone is clinically superior. Our primary objective was to determine if there is a difference in postoperative pain score ratings between adult patients receiving intravenous hydromorphone vs intravenous morphine on discharge from the post-anesthesia care unit (PACU). Methods For this historical cohort study, convenience sampling was used to identify the first 605 patients C 18 yr undergoing elective, non-cardiac surgery. Patients were categorized based on treatment in the PACU with hydromorphone (n = 326) or morphine (n = 279). Pain scores (scale of 0–10), nausea/vomiting (scale of 0–3), pruritis (scale of 0–3), and sedation (scale of 0–4), as well as total opioid dose administered from arrival in the PACU until readiness to discharge were evaluated. Results For the primary outcome of pain reported at discharge from the PACU, there was no significant difference between the mean (standard deviation) S. Rodrigues, MD (&) D. Shin, BHSc M. Conway, MD, FRCPC S. Smulski, MD E. Trenker, MD, FRCPC H. Shanthanna, MD, FRCPC J. Paul, MD, MSc, FRCPC Department of Anesthesiology, McMaster University, Health Sciences Centre, 2V9, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada e-mail: [email protected] T. Vanniyasingam, PhD L. Thabane, PhD Department of Health Research Methods, Evidence & Impact, Health Sciences Centre, McMaster University, Hamilton, ON, Canada
hydromorphone numeric rating scale (NRS) [2.8 (1.6)] and the morphine NRS [2.5 (1.5)] after adjusting for potential confounders (adjusted mean difference, 0.10; 95% confidence interval, –0.21 to 0.42; P = 0.53). Similarly, there were no significant between-group differences in length of stay in the PACU, satisfactory analgesia, nausea/vomiting, and sedation. Conclusion This study serves to help guide the decisionmaking process for selecting either morphine or hydromorphone for acute postoperative analgesia. Overall, we found no significant difference for analgesia or for common opioid-related adverse effects between these two opioids in the postoperative period at the time of discharge from the PACU. Furthermore, according to this data, the equipotency ratio of hydromorphone to morphine is closer to 1:6.5 rather than the commonly employed 1:5 ratio. Re´sume´ Objectif Les opioı¨des so
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