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Hydromorphone

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Overview

Hydromorphone is a drug used to relieve moderate to severe pain. Hydromorphone is known by the trade names Dilaudid® and Palladone®. It belongs to a category of drugs known as opioid agonists. It is commonly given to patients who have recently undergone surgery or who have suffered serious injury, and it is given intravenously, intramuscularly, rectally, or orally. Hydromorphone is often sought after by opiate drug abusers as it is one of the most potent of all prescription narcotics.

Details

Hydromorphone, a semi-synthetic μ-opioid agonist, is a hydrogenated ketone of morphine and shares the pharmacologic properties typical of opioid analgesics. Hydromorphone and related opioids produce their major effects on the central nervous system and gastrointestinal tract. These include analgesia, drowsiness, mental clouding, changes in mood, euphoria or dysphoria, respiratory depression, cough suppression, decreased gastrointestinal motility, nausea, vomiting, increased cerebrospinal fluid pressure, increased biliary pressure, pinpoint constriction of the pupils, increased parasympathetic activity and transient hyperglycemia. When injected, particularily intravenously, hydromorphone produces more intense contraction sensation in the muscles and a more powerful 'rush' than other opioids, even more so than heroin (diacetylmorphine).

CNS depressants, such as other opioids, anesthetics, sedatives, hypnotics, barbiturates, phenothiazines, chloral hydrate and glutethimide may enhance the depressant effects of hydromorphone. MAO inhibitors (including procarbazine), first-generation antihistamines (brompheniramine, promethazine, diphenhydramine, chlorpheniramine), beta-blockers and alcohol may also enhance the depressant effect of hydromorphone. When combined therapy is contemplated, the dose of one or both agents should be reduced.

Side Effects

Adverse effects of hydromorphone are similar to those of other opioid analgesics, and represent an extension of pharmacological effects of the drug class. The major hazards of hydromorphone include respiratory and CNS depression. To a lesser degree, circulatory depression, respiratory arrest, shock and cardiac arrest have occurred. The most frequently observed adverse effects are sedation, nausea, vomiting, constipation, lightheadedness, dizziness and sweating.

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Preemptive nerve block studied in vaginal surgery
From OB/GYN News, 11/1/05 by Sharon Worcester

ATLANTA -- Preemptive pudendal nerve blockade had no effect on postoperative pain or use of narcotic analgesia in a prospective randomized study of patients undergoing pelvic reconstructive surgery.

A total of 102 patients undergoing transvaginal pelvic reconstruction under general anesthesia induced by intravenous fentanyl and propofol were randomized in double-blind fashion to receive pudendal block with either bupivacaine 0.25% or normal saline as placebo just before surgery. Patient-reported pain intensity at six time points in the 24 hours after surgery was similar in both groups, as was consumption of patient-controlled hydromorphone at three time points after surgery, Yoram Abramov, M.D., reported at the annual meeting of the American Urogynecologic Society.

Although some clinical studies have suggested that preemptive analgesia may reduce postoperative pain and consumption of postoperative narcotics, no prior studies have evaluated its effects in patients undergoing vaginal surgery, said Dr. Abramov of Northwestern University, Chicago.

Although it is possible that the threshold for the type of pain experienced by women undergoing vaginal surgery was too low to elicit a statistically significant difference in this study, it may be that the preemptive approach simply does not work in this population, he said.

Mean postoperative pain scores in the treatment vs. placebo groups--as measured using a validated visual analog scale of 0-10 points--were 4.63 and 4.80 at 1 hour, 3.71 and 3.87 at 3 hours, 2.89 and 3.10 at 5 hours, 2.85 and 3.12 at 7 hours, 3.22 and 3.47 at 18 hours, and 3.23 and 3.12 at 24 hours. Consumption of patient-controlled hydromorphone in the treatment vs. placebo groups was 1.84 mg and 1.77 mg at 0-3 hours, 1.19 mg and 1.20 mg at 4-7 hours, and 2.89 mg and 2.35 mg at 8-18 hours.

The treatment and placebo groups were similar with regard to the percentage of patients requiring additional boluses of hydromorphone (18% in each group) or ketorolac (8% and 12%), and with regard to 24-hour mean oral hydrocodone consumption (10.6 mg and 12.7 mg) and mean ibuprofen consumption (630 mg and 762 mg).

There were no complications associated with the pudendal nerve block.

BY SHARON WORCESTER

Southeast Bureau

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