Experience with Epidural Hydromorphone for Post-Thoracotomy Pain Relief

Shulman, Matisyahu; Wakerlin, G. E.; Yamaguchi, Lorna; Brodsky, Jay B.

doi:10.1213/00000539-198712000-00026

Cited by 35 publications

(14 citation statements)

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“…Duration of action varies widely. The mean duration of analgesia after the initial dose of epidural hydromorphone was 7.7B0.9 h (range 3-18) in 21 patients after thoracotomy [98]. This was shorter than in some other studies: 11 …”

Section: Spinalmentioning

confidence: 71%

“…Most studies of epidural hydromorphone discuss its use in pain relief postoperatively and after cesarean section, and not with cancer pain [2,19,37,82,98]. A double-blind, randomized, controlled trial of 20 patients comparing the analgesic efficacy of epidural hydromorphone and intrapleural bupivacaine after thoracotomy found that hydromorphone is superior in satisfactory pain outcomes during the first 5 h [37].…”

Section: Painmentioning

confidence: 99%

“…Common with nebulized administration hydromorphone [7,52,69,87,98]. Tolerance develops to some side-effects with repeated administration [7,52,69,98].…”

Section: Respiratorymentioning

confidence: 99%

“…Because of effects on m-and d-receptors in the bowel, increased intestinal resting tone with periodic spasm and decreased amplitude of nonpropulsive contraction occurs [7,52,59,69,98]. The incidence of nausea and vomiting is 9% with epidural hydromorphone [98], as against 17-35% with epidural morphine [99].…”

Section: Gastrointestinal Tractmentioning

confidence: 99%

“…The incidence is the same with intravenous and epidural hydromorphone [43], but less with oral and rectal hydromorphone [91]. It is caused by stimulation of the medullary emetic chemoreceptor trigger zone [7,52,59,98]. Decreased nausea, vomiting and urinary retention with epidural hydromorphone occurs when it is combined with nalbuphine [84].…”

Section: Gastrointestinal Tractmentioning

confidence: 99%

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Hydromorphone: pharmacology and clinical applications in cancer patients

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Hydromorphone is a more potent opioid analgesic than morphine and is used for moderate to severe pain. It can be administered by injection, by infusion, by mouth, and rectally. Oral bioavailability is low. The kidney excretes hydromorphone and its metabolites. Some metabolites may have greater analgesic activity than hydromorphone itself but are unlikely to contribute to the pharmacological activity of hydromorphone. With the exception of pruritus, sedation and nausea and vomiting, which may occur less after hydromorphone than after morphine, the side-effects of these drugs are similar. On a milligram basis hydromorphone is five times as potent as morphine when given by the oral route, and 8.5 times as potent as morphine when given intravenously.

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Section: Spinalmentioning

confidence: 71%

Section: Painmentioning

confidence: 99%

“…Common with nebulized administration hydromorphone [7,52,69,87,98]. Tolerance develops to some side-effects with repeated administration [7,52,69,98].…”

Section: Respiratorymentioning

confidence: 99%