Intrathecal hydromorphone added to hyperbaric bupivacaine for postoperative pain relief after knee arthroscopic surgery

Lee, Yoon Sook; Park, Young Cheol; Kim, Jaehwan; Kim, Woon Young; Yoon, Seung Zjoo; Moon, Man Gook; Min, Too Jae

doi:10.1097/eja.0b013e3283476055

Cited by 14 publications

(13 citation statements)

References 24 publications

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“…In this cohort of 20 patients, only one participant experienced nausea and pruritus, side effects commonly associated with intrathecal opioid administration [ 14 ]. Others have previously reported that reductions in the dose of intrathecal hydromorphone can reduce the incidence of these side effects [ 15 ]. Although our study was not designed or powered to statistically assess these side effects, the ability to rationally approach the dosing of intrathecal hydromorphone using the ED 50 of the drug should help to mitigate side effects by exposing patients to only the minimal necessary dose.…”

Section: Discussionmentioning

confidence: 99%

Determination of ED50 and time to effectiveness for intrathecal hydromorphone in laboring patients using Dixon’s up-and-down sequential allocation method

O’Reilly-Shah

Lynde

2018

BMC Anesthesiol

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BackgroundWith the increasing occurrence of drug shortages, understanding the pharmacokinetics of alternative intrathecal opioid administration has gained importance. In particular, additional data are needed to comprehensively evaluate the analgesic properties of intrathecal hydromorphone in the laboring patient. In a phase 2 clinical trial, we set out to determine the median effective dose (ED50) and time to effectiveness for this drug in this population.MethodsUsing Dixon’s up-and-down sequential allocation method, twenty women presenting for labor analgesia were prospectively enrolled. A combined spinal-epidural technique was used to deliver the determined dose of intrathecal hydromorphone. Visual analog pain scores were obtained assessing peak pain scores during serial uterine contractions. Effective pain relief was defined as achieving a pain score of less than or equal to 3 out of 10. The dose was deemed to be ineffective if the patient failed to achieve this level of relief after 30 min.ResultsThe ED50 of hydromorphone in our population was 10.9 μg (95% confidence interval 5.6–16.2 μg). Amongst patients for whom the dose was effective, the median time to pain relief was 24 min. One patient experienced both nausea and pruritus. No other complications were noted.ConclusionDue to the prolonged time to onset, hydromorphone cannot be recommended in favor of substantively better alternatives such as sufentanil and fentanyl.Trial registrationClinicaltrials.gov registration number: NCT01598506.

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Section: Discussionmentioning

confidence: 99%

Determination of ED50 and time to effectiveness for intrathecal hydromorphone in laboring patients using Dixon’s up-and-down sequential allocation method

O’Reilly-Shah

Lynde

2018

BMC Anesthesiol

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“…To demonstrate its protective effect, we used hydromorphone to induce oxidative stress-related injury. Because there are few in vitro studies using hydromorphone, we choose an equi-analgesic dosage of hydromorphone as compared to morphine, based on previous studies (Min et al 2011 ; Lee et al 2012 ). Pilot studies determined the maximum effective dose of hydromorphone for a pre-/per-conditioning effect, which was 100 nM (Fig.…”

Section: Discussionmentioning

confidence: 99%

The protective effect of hydromorphone to ischemia in rat glial cells

Kim

et al. 2016

SpringerPlus

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BackgroundIschemic insults during operation can cause ischemic-reperfusion injuries in brain as well as memory impairments. Total intravenous anesthesia (TIVA) is the preferred anesthetic method in brain surgery, as it utilizes motor evoked potential monitoring. And the use of opioids is common in TIVA. However there are few studies about ischemic protective effect of opioids to glial cells.MethodsWe used mixed cultures of rat glial cells, which were harvested from the brain of 1-day old rat. We divided the experimental groups according to their hydromorphone conditioning period: (a) pre-culture, (b) per-culture, or (c) pre- and per-culture. We measured the levels of the reactive oxygen species (ROS) induced by tert-butyl hydroperoxide (TBH) using flow cytometry. The ROS levels in the glial cells were also measured after the administration of 100 nM hydromorphone and selective opioid receptor antagonists.ResultsThe ROS levels were reduced in the hydromorphone-treated group, as compared to the control group (only TBH treated). There were no differences between pre-conditioned and per-conditioned groups. However, the ROS levels were more reduced in pre- and per-conditioned group compared to pre-conditioned or per-conditioned only groups. Furthermore, selective antagonists for the delta, kappa, or mu opioid receptor partially negated the hydromorphone effect.ConclusionThis study demonstrated that hydromorphone can have additional protective effects on oxidative stress when pre- and per-conditioning is combined. Furthermore we proved that μ, δ, κ opioid receptors participate in protective mechanism of hydromorphone to glial cells.

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“…Although the addition of hydromorphine [43] can be questioned [44], fentanyl appears a rather accustomed opioid adjuvant in ambulatory spinal anesthesia [4,5,8 && ,9 & ,42]. Intrathecal fentanyl 10 mg caused no [4] ] compared the Bromage scale with a quantitative measure of muscle strength (commercially available, bedside force dynamometer) in 20 patients who received spinal anesthesia with hyperbaric bupivacaine 10 mg. Because the quantitative measurement proved superior as predictor of the patient's capacity to walk safely, the authors ponder that such a method may be recommended in the clinical setting.…”

Section: Adjuvantsmentioning

confidence: 99%

Short-acting spinal anesthesia in the ambulatory setting

Förster

2014

Current Opinion in Anaesthesiology

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Intrathecal articaine (off-label use for the time being), chloroprocaine, and prilocaine (the latter two officially approval in several European countries) remain a very appealing option in the ambulatory setting. Chloroprocaine may have a slight edge as regards ultra-short and short surgery, whereas articaine and prilocaine may suit well for somewhat longer procedures. Future follow-up investigations should establish possible differences between these local anesthetics, also with respect to other anesthetic techniques and to economical aspects.

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Intrathecal hydromorphone added to hyperbaric bupivacaine for postoperative pain relief after knee arthroscopic surgery

Abstract: The analgesic effects of 5 and 10 μg intrathecal hydromorphone provided satisfactory pain relief for 12 h postoperatively and nausea increased significantly in a dose-dependent manner.

Cited by 14 publications

References 24 publications

Determination of ED50 and time to effectiveness for intrathecal hydromorphone in laboring patients using Dixon’s up-and-down sequential allocation method

Determination of ED50 and time to effectiveness for intrathecal hydromorphone in laboring patients using Dixon’s up-and-down sequential allocation method

The protective effect of hydromorphone to ischemia in rat glial cells

Short-acting spinal anesthesia in the ambulatory setting

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