Abstract

CADAVID, Adriana M et al. Tolerability and efficacy of morphine vs. hydromorphone in postoperative epidural analgesia: double-blind randomized control trial. Rev. colomb. anestesiol. [online]. 2010, vol.38, n.3, pp.319-333. ISSN 0120-3347.

Introduction. The acceptance (tolerability) of epidural analgesia can be compromised by the side effects of opioids. This study compares the side effects and efficacy of hydromorphone or morphine combined with bupivacaine in postoperative epidural analgesia. Methods. Double-blind prospective randomized controlled trial at Hospital Universitario San Vicente de Paul; 147 patients were randomized in two groups: 73 patients of the MB Group received 30 jug per ml of morphine with bupivacaine 0.1 % and 74 patients of the HB group received 10 ug per ml of hydromorphone with bupivacaine 0.1 %. Results. The main outcome was the tolerability defined by the frequency of nausea and vomiting sedation urinary retention and pruritus bettween the groups at 24 hours. 142 patients were analyzed: 71 in group MB and 71 in group HB. The incidence of nausea was 36.6 % and 31 % (p = 0.54); vomiting 19.7 % and 25.4 % (p = 0.42); sedation 15.5 % and 14.1 % (p = 0.81); urinary retention 11.3 % and 7 % (p = 0.38); and pruritus 43.7 % and 31 % (p = 0.11) for groups MB and HB respectively. Five patients were excluded either because of catheter migration or disconnection. No statistically significant differences were found between the groups. The verbal numerical scale (VNS) of dynamic pain at 24 hours was 3.42 (+/- 2.8) y 2.82 (+/- 2.5) for groups MB and HB respectively (p = 0.16) Conclusions. The choice between 30 ¡ug per ml of morphine or 10 mcg per ml of hydromorphone does not influence the incidence of side effects or the efficacy of this technique.

Keywords : Pain; postoperative; analgesia; epidural; analgesics; opioid; central nervous system; drug tolerance.

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