Intrathecal hydromorphone for postoperative analgesia after cesarean delivery: a retrospective study.

Despite compelling evidence for the safety and efficacy of intrathecal hydromorphone, the use of this opioid intrathecally for the pain management of patients undergoing cesarean delivery has not been widely accepted. The purpose of this retrospective study was to compare the reported efficacy and safety of pain management in women who received intrathecal hydromorphone (100 microg) vs in women who received intrathecal fentanyl (25 microg) or a local anesthetic for their cesarean delivery. The author hypothesized that intrathecal hydromorphone because of its known pharmacodynamics would provide better postoperative analgesia within the first 24 hours after cesarean delivery. The results of this retrospective chart review confirmed the hypothesis that intrathecal hydromorphone possesses the appropriate pharmacodynamics to facilitate optimal pain relief in patients undergoing cesarean delivery. It provided a comparable onset of effective pain relief, as well as a significantly prolonged duration of pain relief (P < .001) compared with intrathecal fentanyl or local anesthetic. Traditionally, intrathecal morphine was the opioid of choice for prolonged pain management during cesarean deliveries in which spinal anesthesia was selected. However, intrathecal hydromorphone was shown to be an effective and possibly even better substitute. Further research on intrathecal hydromorphone is needed.