Key result
Epidural hydromorphone with epinephrine significantly prolonged the duration of analgesia compared to hydromorphone alone after cesarean delivery (24.3 vs 18.2 hours; p<0.01).
Why the study?
Does adding epinephrine to epidural hydromorphone prolong the duration of postoperative analgesia in healthy women undergoing cesarean delivery?
RCT (n=30)
Randomly assigned
Does adding epinephrine to epidural hydromorphone prolong the duration of postoperative analgesia in healthy women undergoing cesarean delivery?
Absolute Event Rate: 24.3% vs 18.2%
p-value: p=<0.01
The addition of epinephrine to epidural hydromorphone significantly hastens the onset and prolongs the duration of postoperative analgesia after cesarean delivery without increasing side effects.
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May extend post-cesarean epidural analgesia; leaves open confirmation of safety and efficacy in larger trials.
The efficacy of epidural hydromorphone alone or in combination with epinephrine for postoperative analgesia was evaluated in 30 healthy women who underwent cesarean delivery with epidural anesthesia. They were assigned randomly to receive either 1.5 mg hydromorphone alone (N = 15) or 1.5 mg hydromorphone with 1/200,000 epinephrine (N = 15). Duration of analgesia (mean +/- SD) was 24.3 +/- 9.4 hours after the epidural injection of hydromorphone plus epinephrine. This was significantly greater (p less than 0.01) than the duration of 18.2 +/- 5.9 hours after the same dose of plain hydromorphone. Analgesia was more rapid in onset and significantly better at the 0.5, 1, 3, and 12 hours postoperatively in the hydromorphone-epinephrine group. Side effects including pruritus (73%), nausea (20%), and vomiting (15%) were of similar frequency with and without epinephrine. Although mean venous PCO2 (PvCO2) levels three and six hours after the hydromorphone-epinephrine dose were elevated significantly over the pre-drug PvCO2 levels, no respiratory depression was detected by an apnea monitor to which all patients were connected. The addition of epinephrine to epidural hydromorphone hastened onset and prolonged the duration of analgesia after cesarean section.
Dougherty et al. (1989) conducted an RCT in Post-operative analgesia after cesarean delivery (n=30). Epidural hydromorphone with epinephrine vs. 1.5 mg hydromorphone alone was evaluated on Duration of analgesia (p=<0.01). Epidural hydromorphone with epinephrine significantly prolonged the duration of analgesia compared to hydromorphone alone after cesarean delivery (24.3 vs 18.2 hours; p<0.01).
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