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Objective:To investigate the effects of different analgesic methods of hydromorphone on analgesic efficacy and sleep quality in patients with refractory cancer pain.Methods:Sixty patients with refractory cancer pain who received three-step analgesic treatment in Quzhou People's Hospital from August 2018 to December 2019 and acquired poor analgesic effects were included in this study. They were randomly assigned to undergo either an intravenous patient-controlled analgesia with hydromorphone (HV group, n = 30) or an intrathecal patient-controlled analgesia with hydromorphone (HI group, n = 30) for 10 consecutive days. The analgesic efficacy in each group was evaluated using the numerical rating scale (NRS) before and 2, 4, 24, 48 hours, and 10 days after administration. The frequency of breakthrough pain (BTP) at each time point was recorded. The sedation effect of medication was evaluated using the Ramsay score. The sleep quality of patients was evaluated using the Pittsburgh sleep quality index (PSQI). The activities of CD 3+, CD 4+, and CD 4+/CD 8+ lymphocyte subsets were measured by flow cytometry at different time points. The adverse reactions within 10 days after treatment were observed and recorded. Results:Before and at each time point after treatment, there were no significant differences in NRS score, the frequency of BTP, Ramsay score, and PSQI score between the two groups (NRS score: t = 0.45, 0.91, 0.52, 1.19, 0.97, 1.92, all P > 0.05; frequency of BTP: t = 0.34, 1.88, 0.86, 1.71, 1.22, 0.76, all P > 0.05; Ramsay score: t = 0.56, 0.46, 0.63, 0.22, 0.99, 0.14, all P > 0.05; PSQI: t = 0.86, 1.25, 1.46, 1.05, 0.57, 1.93, all P > 0.05). At each time point after treatment, the activities of CD 3+, CD 4+, and CD 4+/CD 8+ cells increased in each group, and the activities of CD 3+, CD 4+, and CD 4+/CD 8+ cells in the HI group were significantly higher than those in the HV group (CD 3+: t = 3.72, 3.12, 2.85, 3.13, 2.44, all P < 0.05; CD 4+: t = 3.62, 2.45, 3.31, 3.19, 2.70; all P > 0.05; CD 4+/CD 8+: t = 3.10, 2.74, 2.83, 3.24, 3.41, all P < 0.05). The total incidence of adverse reactions was slightly, but not significantly, lower in the HI group than the HV group [14.00% (7/30) vs. 26.00% (13/30), χ2 = 2.70, P = 0.100]. Conclusion:Compared with intravenous administration of hydromorphone, intrathecal administration of hydromorphone can better effectively relieve pain, decrease the frequency of BTP, improve sleep quality, has a good sedative effect, improve immune function, and has fewer adverse reactions.
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Objective:To investigate the efficacy and safety of hydromorphone for postoperative analgesia in children with congenital heart disease, and provide a suitable reference dose for postoperative analgesia in children.Methods:Using a prospective study, 157 patients with congenital heart disease(ASA Ⅱ- Ⅳ) admitted to pediatric intensive care unit at Children′s Hospital of Chongqing Medical University from November 2019 to November 2021 were randomly divided into five groups.Low-dose hydromorphone group (H1 group, 30 cases): hydromorphone dose ≥2 and <3 μg/(kg·h), hydromorphone medium-dose group (H2 group, 30 cases): hydromorphone dose ≥3 and <4 μg/(kg·h), high-dose hydromorphone group (H3 group, 31 cases): hydromorphone dose ≥4 and ≤5 μg/(kg·h), sufentanil group (S group, 36 cases): the dose of sufentanil was 0.08 μg/(kg·h), morphine group (M group, 30 cases): the dose of morphine was 20 μg/(kg·h). The five groups of children received midazolam 2 μg/(kg·min) intravenously at the same time as sedative therapy.Pain score and sedation score were scored at 1 h, 4 h, 8 h, 12 h, and 24 h after operation.Heart rate, mean arterial pressure, blood glucose, lactate, and serum cortisol levels were also monitored and detected, and the occurrence of adverse reactions, the number of cases requiring additional analgesic and sedative drugs, as well as the duration of mechanical ventilation were compared.Results:(1) There were no significant differences regarding the age, body weight, cardiopulmonary bypass time, pediatric critical illness score and ASA score among five groups (all P>0.05). (2) There was no significant difference in the levels of respiration, heart rate, blood sugar, lactate and serum cortisol among five groups after operation.There was no significant difference in preoperative mean arterial pressure among the groups, but there was significant difference in the postoperative mean arterial pressure among the groups at 4 h and 8 h( P<0.05). (3) The analgesic satisfaction of H1 group, H2 group and H3 group at 1 h, 4 h, 12 h and 24 h after operation was significantly higher than that in M group ( P<0.05). There was no significant difference in analgesic satisfaction among H1 group, H2 group and H3 group at each time point.(4) The sedation satisfaction of H1 group, H2 group and H3 group at 4 h and 24 h after operation was significantly higher than that in M group ( P<0.05). There was no significant difference in sedation satisfaction among H1 group, H2 group and H3 group at each time point.(5) There was no significant difference in postoperative analgesia satisfaction and sedation satisfaction between H1 group, H2 group, H3 group and S group.(6) Children in H1 group[1(0, 2)], H2 group[1(0, 2)], H3 group[1(0, 2)] had fewer additional doses within 24 hours than that in M group[2(2, 3)]( P<0.05), and fewer children in H1 group, H2 group and H3 group had been given analgesic sedatives than that in M group ( P<0.05); The extubation time was shortest in H2 group and S group[H2 group(88.3±2.9) h, S group(85.9±3.0) h]. (7) There were no adverse reactions in H1 group, H2 group, H3 group and S group, and there were two cases of apnea in M group. Conclusion:The analgesic effect of hydromorphone in children with congenital heart disease after surgery is better than that of morphine, and the effect of hydromorphone is comparable to that of sufentanil.Hydromorphone 3-4 μg/(kg·h)+ midazolam 2 μg/(kg·min) can achieve satisfactory analgesic and sedative effects in children after congenital heart surgery, with few adverse reactions, safe and reliable, which is an excellent choice for postoperative analgesia and sedation in children.
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Objective:To explore the clinical effects and adverse reactions of hydromorphone versus morphine subcutaneous injection analgesia for cancer outbreak pain.Methods:A total of 98 patients with cancer outbreak pain admitted to Xuzhou Central Hospital were selected. According to the random number table method, the patients were divided into the observation group (receiving subcutaneous injection of hydromorphone for analgesia) and the control group (receiving subcutaneous injection of morphine for analgesia), 49 cases in each group. The numerical rating scale (NRS) scores and quality of life (QOL) scores, pain relief effects, serum β-endorphin, substance P, 5-hydroxytryptamine levels and the incidence of adverse reactions were compared between the two groups.Results:The NRS scores of the two groups after treatment were decreased compared with those before treatment (all P < 0.05); and the NRS score of the observation group was lower than that of the control group after treatment [(2.4±0.4) scores vs. (3.2±0.5) scores, t = 8.69, P < 0.001]; the QOL scores of the two groups after treatment were higher than those before treatment (all P < 0.05); and there were no statistically significant difference in QOL scores after treatment between the two groups [(46±7) scores vs. (43±7) scores, t = 1.62, P = 0.109]. The total effective rate of pain relief of the observation group was higher than that of the control group [93.88% (46/49) vs.79.59% (39/49), χ2 = 4.35, P = 0.037]. The serum β-endorphin, substance P, 5-hydroxytryptamine levels of the two groups after treatment were decreased compared with those before treatment (all P < 0.05). β-endorphin, substance P and 5-hydroxytryptamine of the observation group were lower than those of the control group after treatment[β-endorphin: (85±15) ng/L vs. (98±17) ng/L, substance P: (2.1±0.3) μg/ml vs. (2.4±0.4) μg/ml, 5-hydroxytryptamine: (0.31±0.05) ng/L vs.(0.38±0.06) ng/L; t values were 3.75, 3.63, 6.27, all P < 0.05). Compared with the control group, the incidence of adverse reactions like skin pruritus, nausea and vomiting of the observation group were lower (all P < 0.05). Conclusions:Compared with subcutaneous injection of morphine for analgesia, hydromorphone can better alleviate the pain of patients with cancer outbreak pain, decrease the level of pain mediators, and reduce the incidence of skin pruritus, nausea and vomiting.
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Objective:To investigate the effect of hydromorphone combined with ropivacaine on hemodynamics, maternal and infant outcomes in labor analgesia.Methods:From April 2018 to April 2020, 150 pregnant women with single full-term pregnancy undergoing labor analgesia in Meishan Hospital Affiliated of West China Hospital, Sichuan University were randomly divided into two groups, with 75 cases in each group. The control group was given ropivacaine for labor analgesia, while the observation group was given hydromorphone combined with ropivacaine for labor analgesia. The scores of visual analogue scale (VAS), heart rate (HR), mean arterial pressure (MAP) and blood oxygen saturation (SpO 2) at the time of entering the room (T 1), after the first dose for 5 min (T 2), 10 min (T 3), after delivery for 30 min (T 4) and 60 min (T 5) were compared between the two groups. Results:The scores of VAS at T 2, T 3, T 4, T 5 in two group were decreased, and the scores of VAS in the observation group were lower than that in the control group: (5.12 ± 0.98) scores vs. (7.11 ± 1.10) scores, (4.39 ± 0.61) scores vs. (5.77 ± 0.75) scores, (3.12 ± 0.38) scores vs. (4.88 ± 0.91) scores, (2.12 ± 0.37) scores vs. (3.98 ± 1.11) scores, the differences were statistically significant ( P<0.05). The levels of HR, MAP, SpO 2 in two groups at different time point had no significant differences ( P>0.05). There were no significant difference between the first stage of labor, the second stage of labor and the third stage of labor ( P>0.05). There was no significant difference in the 5 min Apgar score of newborns and the incidence of maternal adverse reactions between the two groups ( P>0.05). Conclusions:Hydromorphone combined with ropivacaine for labor analgesia effect is ideal, and has little impact on hemodynamics of patients, and will not increase the safety risk of mother and infant.
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Background: The efficacy and safety of continuous subcutaneous injection (CSCI) of hydromorphone hydrochloride (HM) for titration of moderate to severe cancer pain have yet to be evaluated. Methods: We retrospectively analyzed the patients underwent CSCI of HM from Feb. 2020 to Oct. 2021 in Kitano Hospital, Osaka, Japan. The concentration of HM was 0.20 mg/ml to 1.0 mg/ml in saline depending on the patient. Haloperidol was added to a concentration of 0.5 mg/ml for a total of 10 ml. CSCI was performed using a portable small syringe driver. The dose was titrated between 0.05 ml/h and 1.0 ml/h to achieve adequate relief of pain without unacceptable side effects. Results: A total of 37 patients including 1 opioid-naive patient were examined. The median dose of HM at the initiation and completion of titration was 1.92 and 2.40 mg/day, respectively. The median time to titration completion was 2 days. Titration completion rate within 3 days was observed in 33 patients (89%). Remarkable effect to pain (at least 66% improvement in numerical rating scale [NRS]) was observed in 33 patients (89%), efficacy (33 to 66% improvement in NRS) in 3 patients (8.1%), and inefficacy in 1 patient (2.7%). Adverse events included Common Terminology Criteria for Adverse Events Grade 2 drowsiness in 3 patients (8.1%) and Grade 2 hypotension in 1 patient (2.7%), both of which improved with reduction or discontinuation of HM. Conclusion: CSCI of HM was simple and safe, and produced rapid and effective pain control for moderate to severe cancer pain.
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Objective:To evalaute the efficacy of butorphanol mixed with different doses of hydromorphone in improving patient-controlled intravenous analgesia (PCIA) after secondary cesarean section.Methods:Two hundred American Society of Anesthesiologists physical status Ⅱsingleton pregnant parturients, aged 18-45 yr, at 37-42 week gestation, with body mass index≤30 kg/m 2, undergoing elective secondary cesarean section under combined spinal-epidural anesthesia, were allocated to one of 4 groups ( n=50 each) using a random number table method: butorphanol (group B) and butorphanol mixed with different doses of hydromorphone groups (group BH 1, group BH 2 and group BH 3). Flurbiprofen 50 mg, butorphanol 1 mg and granisetron 3 mg were intravenously injected after delivery during operation.The analgesic pump was connected and turned on at the end of operation.The PCIA solution contained butorphanol 0.24 mg/kg and granisetron 6 mg in group B, butorphanol 0.24 mg/kg and hydromorphone 0.06 mg/kg and granisetron 6 mg in group BH 1, butorphanol 0.24 mg/kg and hydromorphone 0.09 mg/kg and granisetron 6 mg in group BH 2, butorphanol 0.24 mg/kg and hydromorphone 0.12 mg/kg and granisetron 6 mg in group BH 3.The PCIA solution was diluted with normal saline to 150 ml, and the patient-controlled analgesia (PCA) pump was set up to deliver a 3.0 ml bolus dose with a 15-min lockout interval and background infusion at 2.5 ml/h in all the four groups.The degree of pain was evaluated using the VAS score.When the VAS score>5 points after pressuring analgesia pump at rest, flurbiprofen axetil 50 mg was intravenously injected for rescue analgesia.VAS scores during movement, at rest and during uterine contraction and observer′s assessment of alertness/sedation scale score were recorded at 3, 6, 24 and 48 h after operation.The requirement for rescue analgesia, effective pressing times of PCA, overall satisfaction score, OAA/S score<5, adverse reactions and time to the first flatus were recorded within 48 h after operation. Results:Compared with group B, VAS scores in different states were significantly decreased after operation, the effective pressing times of PCA were decreased within 48 h after surgery, and the overall satisfaction score was increased in BH 1, BH 2 and BH 3 groups ( P<0.05). Compared with group BH 1, no significant change was found in VAS score in different states after operation in group BH 2 ( P>0.05), and VAS score was significantly decreased at rest after operation in group BH 3 ( P<0.05). There was no significant difference in VAS scores between group BH 2 and group BH 3 ( P>0.05). There were no significant differences in the requirement for rescue analgesia, effective pressing times of PCA and overall satisfaction of the puerperae among BH 1, BH 2 and BH 3 groups ( P>0.05). There was no significant difference in the time to the first flatus after operation, requirement for rescue analgesia and incidence of observe′s assessment of alterness/sedation scale score<5 and adverse reactions among the four groups ( P>0.05). Conclusions:Compared with butorphanol alone, butorphanol mixed with hydromorphone is helpful in reducing maternal pain and improving the overall satisfaction, with fewer adverse reactions.Butorphanol 0.24 mg/kg mixed with hydromorphone 0.09 mg/kg is recommended.
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Objective:To evaluate the efficacy of S-ketamine mixed with hydromorphone for improving patient-controlled intravenous analgesia (PCIA) after lumbar spinal surgery.Methods:Ninety-six American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 18-64 yr, with body mass index of 18.5-29.9 kg/m 2, scheduled for elective lumbar fusion surgery under general anesthesia, were divided into 2 groups ( n=48 each) using a random number table method: hydromorphone for PCIA group (group H) and S-ketamine mixed with hydromorphone for PCIA group (group S+ H). PCIA was performed at the end of operation.PCIA solution contained hydromorphone 0.05 mg/ml mixed with S-ketamine 0.25 mg/ml in group S+ H and hydromorphone 0.05 mg/ml in group H. The PCIA pump was set up to deliver a 2 ml bolus dose with a 10-min lockout interval, background infusion at 2 ml/h and total volume of 200 ml.When the numerical rating scale score ≥4 and analgesia was ineffective by pressing the PCA pump for 3 consecutive times, hydromorphone 0.2 mg was intravenously injected as rescue analgesic.The cumulative consumption of hydromorphone (consumption for analgesic pump and consumption for rescue analgesia) and occurrence of adverse reactions such as pruritus, respiratory depression, nausea, vomiting, drowsiness, dizziness, headache, hallucinations and nightmares within 48 h after operation were recorded.The patients′ satisfaction with analgesia was recorded at 48 h after operation.The time to first flatus after operation and quality of recovery (QoR-15 scale) at 24 and 48 h after operation were recorded. Results:Compared with group H, the cumulative consumption of hydromorphone within 48 h after surgery were significantly reduced, the patients′ satisfaction with analgesia was increased, the time to first flatus after operation was shortened, QoR-15 scores were increased at 24 and 48 h after operation ( P<0.05), and no significant change was found in the requirement for rescue analgesia and incidence of adverse reactions within 48 h after surgery in group S+ H ( P>0.05). Conclusions:Compared with PCIA with hydromorphone, S-ketamine mixed with hydromorphone can reduce postoperative consumption of hydromorphone, increase satisfaction with analgesia, and promote early postoperative recovery after lumbar spinal surgery.
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Objective:To investigate the effects of hydromorphone on early postoperative recovery, postoperative analgesia and stress response in patients undergoing laparoscopic radical resection of colorectal cancer.Methods:120 patients with colorectal cancer who underwent laparoscopic radical resection of colorectal cancer in Taizhou Hospital of Zhejiang Province from June 2019 to June 2020 were included in this study. They were randomly assigned to undergo either postoperative patient-controlled intravenous analgesia with hydromorphone (observation group, n = 60) or postoperative patient-controlled intravenous analgesia with sugentanil (control group, n = 60). The changes of perioperative indexes, postoperative recovery, Visual Analogue Scale score at 3, 12 and 24 hours post-surgery, stress response [norepinephrine, interleukin-6 and cortisol] before and 3 days after surgery were compared between the two groups. Results:There were no significant differences in operative time and intraoperative blood loss between the two groups (both P > 0.05). The time to intestinal peristalsis, the time to getting out of bed, and the time to drainage tube removal in the observation group were (57.83 ± 8.98) hours, (43.12 ± 2.34) hours, and (121.38 ± 10.29) hours, which were significantly shorter than those in the control group [(65.21 ± 7.45) hours, (45.46 ± 2.19) hours and (150.28 ± 13.42) hours, t = 4.899, 5.656 and 13.238, all P < 0.05]. Visual Analogue Scale score in the observation group at 12 and 24 hours after surgery was (1.89 ± 0.27) points and (1.45 ± 0.23) points, respectively, which was significantly lower than that in the control group [(2.19 ± 0.24) points, (1.84 ± 0.20) points, t = 6.433, 9.911, both P < 0.05]. At 3 days after surgery, serum levels of norepinephrine, interleukin-6 and cortisol in the observation group were (185.49 ± 18.29) ng/L, (59.91 ± 6.89) ng/L, and (109.21 ± 15.46) μg/L, respectively, which were significantly lower than those in the control group [(235.41 ± 16.57) ng/L, (73.24 ± 7.68) ng/L, (128.39 ± 10.32) μg/L, t = 15.668, 10.008, 7.993, all P < 0.05]. Conclusion:Hydromorphone exhibits a good effect on laparoscopic radical resection of colorectal cancer because it can promote early postoperative recovery, has an obvious postoperative analgesic effect and little influence on stress response.
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In Japan, there are not many reports of using hydromorphone for patients with renal failure and occurring neurotoxicity such as disturbance of consciousness. This report includes two cases of consciousness disorder such as delirium when hydromorphone was started or increased in patients with renal dysfunction. In the case 1, delirium appeared when hydromorphone dosage was increased from 2.4 mg to 3.6 mg intravenously for cancer pain. After reduction of dosage, consciousness disorder was improved. In the case 2, delirium also appeared when oral hydromorphone started at 2 mg for cough and dyspnea. After discontinuation of hydromorphone, the disturbance of consciousness was improved. In both cases, hydromorphone improved cancer pain, cough, and dyspnea, but it was difficult to continue hydromorphone due to adverse events, and opioid switching was required. Although there are reports of neurotoxicity caused associated with the use of high-dose, long-term hydromorphone in patients with renal failure, neurotoxicity may be shown even with small doses and short-term administration.
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Background: Hydromorphone is an analogue of morphine used in the treatment of cancer-related pain. There have been few studies that have evaluated the analgesic effect upon transition from hydromorphone injections. The aim of this study was to evaluate the conversion ratio between injection and oral preparation. Methods: We conducted a retrospective chart study of consecutive patients who were admitted to our hospital between July 2018 and December 2019. Results: In six patients, when the conversion ratio from hydromorphone injection to oral was changed at a 1:5 conversion ratio, three patients obtained adequate analgesic effects, the analgesic effect was insufficient in one case and an increased dose was required. Significant drowsiness appeared in two patients who required a decrease in dose. Conclusions: In converting from hydromorphone injections to oral preparations, it is necessary to carefully monitor the analgesic effect and adverse events and adjust the dosage for each case regardless of the conversion ratio.
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We report that the discontinuation of haloperidol during subcutaneous infusion therapy with hydromorphone citrate led to the improvement of subcutaneous induration. A 70-year-old female was admitted to our palliative care unit with neck pain. She had neck lymph node metastasis from carcinoma of unknown origin. As subcutaneous infusion of hydromorphone citrate caused nausea, we administered haloperidol with hydromorphone citrate in normal saline. The infusion sites after 4, 9, and 11 days were changed because of subcutaneous induration, which we considered to be caused by haloperidol. After discontinuation of haloperidol, induration at the infusion site was not observed.
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This retrospective study investigated the incidence of subcutaneous induration induced by hydromorphone citrate (HM) and haloperidol (HPD). From September 2018 to December 2019, 75 consecutive patients admitted to our palliative care unit were enrolled. A total of 177 subcutaneous injection sight reactions were assessed from the study initiation to data collection. Patients were then classified into three groups: group A, administered HM + normal saline (NS); group B, administered HM + HPD + NS; and group C, administered HM + HPD + 5% glucose water (Glu). Subcutaneous indurations were observed 29 times at the median of 71.0 (27–151) h. The incidence rates of subcutaneous induration were 4.7% (4/86), 39.1% (18/46), and 15.6% (7/45) in groups A, B, and C, respectively. A significant difference in this rate was observed between groups A and B and between groups B and C. The incidence rates of subcutaneous induration were low in the HM + NS group, but it rose by the addition of haloperidol significantly. Changing from NS to Glu as dilution liquid for HM + HPD decreased subcutaneous induration incidence.
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We reported a clinical case in which decreased concentration of hydromorphone citrate in subcutaneous infusion therapy led to the improvement of subcutaneous induration. A subcutaneous infusion therapy with hydromorphone citrate was initiated in a 60-year-old female pancreatic-cancer patient with back pain. A subcutaneous induration has emerged when the infused concentration of hydromorphone citrate was increased from 0.17% to 0.83%. After the reduction in its concentration (0.28%), that subcutaneous induration has improved. For the alleviation of nausea and sedation, administration of haloperidol and midazolam were added at day 61 and day 70, respectively, with keeping the low concentration (≤0.28%) of hydromorphone citrate. Under this condition, further occurrence of subcutaneous induration was not observed. As a result, we suggested that the concentration of hydromorphone citrate in subcutaneous infusion therapy determined the onset of subcutaneous induration.
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We report that switching from high concentration morphine citrate to high concentration hydromorphone citrate was effective at reducing the frequency of subcutaneous induration due to subcutaneous infusion and relieving pain. A 66-year-old male was admitted to our palliative care unit with neck pain. He was suffering from neck lymph node metastasis from a carcinoma of unknown origin. We administered a subcutaneous infusion of high concentration morphine citrate (40 mg/ml); however, the infusion site had to be changed about every 3 days because subcutaneous induration occurred and pain-relieving effect of the drug was attenuated. After switching to high concentration hydromorphone citrate (10 mg/ml) diluted to 40%, we no longer needed to change the infusion site due to the drug’s osmolality and the fact that it was a weak irritant and its pH was normalized by its dilution with normal saline. It is worth switching from high concentration morphine citrate to high concentration hydromorphone citrate in terminally ill cancer patients who need subcutaneous infusions of high dose opioids.
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OBJECTIVE: To evaluate the efficacy, safety and economy of tramadol and hydromorphone combined with flurbiprofen axetil in the treatment of PCIA for postoperative cesarean through the empirical study, optimize the drug treatment program and provide certain evidence-based medicine and pharmacoeconomics basis for clinical use of drugs. METHODS: Included 240 cases of maternal, these maternal need to use PCIA for postoperative analgesia and meet the inclusion and exclusion criteria. The maternal samples included in the study were divided into two groups: tramadol(tramadol 2 mg •kg-1 + flurbiprofen axetil 5 mg•kg-1) and hydromorphone(hydromorphone 0.04 mg •kg-1 + flurbiprofen axetil 5 mg•kg-1). The efficacy index, safety index and cost index of the two groups were observed. The effectiveness, adverse reactions and cost data were collected. Statistical analysis and cost effectiveness analysis were used to evaluate the economic effects of the two groups. RESULTS: The analgesic effect of tramadol group was same as the hydromorphone group, but the total cost of analgesia in tramadol group was lower than that in hydromorphone group, the results of the minimum cost analysis showed that the tramadol regimen was superior and the results were stable. CONCLUSION: The PCIA regimen of tramadol group is superior to that of the hydromorphone group, considering the efficacy, safety and economy.
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Objective@#To explore the clinical effect of hydromorphone in the prevention of postoperative hyperpathia in patients receiving remifentanil combined anesthesia.@*Methods@#64 patients who were scheduled to receive abdominal surgery and postoperative analgesia were randomly divided into hydromorphone group(n=32) and control group (n=32) according to random number table.All the cases were given PCIA after surgery, the control group was given fentanyl 12.5μg/kg, and the hydromorphone group was given fentanyl 12.5μg/kg + hydromorphone 10μg/kg.The postoperative analgesic effects at different time, postoperative recovery, usage of PCIA and incidence of adverse effects in two groups were compared.@*Results@#There were no statistically significant differences in respiration recovery time, wake-up time, extubation time between the two groups (t=1.21, 0.83, 0.33, all P>0.05). The levels of MAP, HR after extubation of the hydromorphone group were significantly lower than those of the control group (t=2.84, 2.66, all P<0.05). The VAS scores at 30 min, 1h, 2h, 4h, 12h after operation in the hydromorphone group were significantly lower than those in the control group (t=8.83, 5.25, 8.77, 9.51, 9.69, all P<0.05), while the difference was not statistically significant between the two groups at 24h after operation (t=1.87, P>0.05). The press times and dosage of fentanyl during 1h, 24h after surgery of the hydromorphone group were significantly less than those of the control group(t=16.71, 36.38, 43.05, 10.98, all P<0.05). The adverse reactions between the two groups had no statistically statistical difference (χ2=0.14, P>0.05).@*Conclusion@#Postoperative analgesia of remifentanil combined anesthesia with hydromorphone can effectively prevent RIH, reduce other anesthetics dose, and does not increase the risk of complications.
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Objective@#To evaluate the safety and efficiency of patient-controlled intravenous analgesia (PCIA) using hydromorphone supplement with dexmedetomidine on patients undergoing transcatheter arterial chemoembolization.@*Methods@#One hundred and eighty patients, age ranged from 40 to 65 years, body mass index from 18 to 25 kg/m2, ASA physical status Ⅱ-Ⅲ, who were scheduled for transcatheter arterial chemoembolization (TACE) under monitor anesthesia care (MAC) were randomly divided into 3 groups: hydromorphone group (H group), hydromorphone supplement with dexmedetomidine 1 μg/kg group (D1 group), hydromorphone supplement with dexmedetomidine 2 μg/kg group (D2 group), 60 patients in every group. All the groups of patients received PCIA pump, in the H group, the PCIA reagent was composed of 120 μg/kg hydromorphone and 5 mg tropisetron in 100 ml of normal saline. In comparison, PCIA regiment was composed of 120 μg/kg hydromorphone, 1 μg/kg dexmedetomidine and 5 mg tropisetron in 100 ml of normal saline in the D1 group, while 120 μg/kg hydromorphone, 2 μg/kg dexmedetomidine and 5 mg tropisetron in 100 ml of normal saline in the D2 group. The visual analogue scale (VAS) score, the observer′s assessment of alertness/sedation scale (OAA/S) score, patients′ satisfaction index, consumption of hydromorphone, the additional dose of morphine, the effective pressing times of PCIA and adverse reactions were recorded in detail at 0, 0.5, 1, 4, 12 and 24 hours after the patients underwent TACE.@*Results@#The total consumptions of hydromorphone were (4.3±0.1), (4.1±0.1), and (3.8±0.1) mg in group H, D1, and D2, respectively, and the effective pressing times were 13±3, 6±2 and 2±1, the additional doses of morphine were (30±5), (15±3), and (3±1) mg, and adverse reaction rates were 45.0%, 28.3%, and 10.0%, respectively. The manifestations mentioned above in D2 group were significantly lower than those in group H and group D1 (P<0.05). Immediately and 5 min after embolization, at the end of surgery and 0.5, 1, 4, 12 and 24 h after surgery, the VAS scores in the D2 group were 1.9±0.2, 2.1±0.3, 1.8±0.4, 1.8±0.3, 1.7±0.3, 1.6±0.3, 1.3±0.2, 1.3±0.3, respectively, lower than those in group H and group D1 (P<0.05); The satisfaction index in D2 group at these times were 8.7±1.1, 8.9±0.8, 9.2±0.9, 9.0±0.7, 9.1±0.8, 9.0±0.6, 9.1±0.7, 9.2±0.9, respectively, higher than those in group H and group D1 (P<0.05). No breath depression happened in these three groups.@*Conclusion@#The formula of hydromorphone combined with dexmedetomidine to patients undergoing TACE is greatly safe and efficient, with advantages in alleviating pain, reducing hydromorphone consumption and the incidence of adverse reaction of hydromorphone, and without breath depression.
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OBJECTIVE:To observe analgesia,sedation effects and safety of flurbiprofen axetil combined with hydromorphone for postoperative patient-controlled intravenous analgesia (PCIA) after orthopedics surgery. METHODS:Totally 90 patients with combined spinal epidural anesthesia underwent lower limb surgery were selected from anesthesology department in the Affiliated Hospital of Chengde Medical College during May 2016-Jan. 2018. They were divided into SF group,H group and KH group according random number table,with 30 cases in each group. The postoperative PCIA pump drug liquid formula of SF group included Sufentanil citrate injection 2-3 μ g/kg+Tropisetron hydrochloride for injection 10 mg+0.9% Sodium chloride injection diluted to 100 mL;that of H group included Hydromorphone hydrochloride injection 0.12 mg/kg+Tropisetron hydrochloride for injection 10 mg+0.9% Sodium chloride injection diluted to 100 mL;that of KH group included Hydromorphone hydrochloride injection 0.12 mg/kg+Flurbiprofen axetil injection 50 mg+Tropisetron hydrochloride for injection 10 mg+0.9% Sodium chloride injection diluted to 100 mL. The operation time, intraoperative medication (epidural application frequency of additional ropivacaine,frequency of ephedrine and atropine),effective pressing times of analgesic pump and the analgesic effect of PCIA were observed in 3 groups. VAS score and Ramsay sedation score were observed 2,6,12,24,48 h after surgery. The hospital anxiety and depression scale (HAD) score,profile of mood states (POMS) score and the occurrence of ADR were observed before and after surgery. RESULTS:There was no statistical significance in operation time,epidural application frequency of additional ropivacaine or frequency of ephedrine and atropine among 3 groups (P＞0.05). The effective pressing times of analgesic pump in KH group were significantly lower than SF group and H group. The proportion of patients with excellent and good anesthesia effect in KH group was significantly higher than SF group and H group (P＜0.05);there was no statistical significance between SF group and H group(P＞0.05). VAS score of 3 groups 48 h after surgery were significantly lower than 6, 12,24 h after surgery;that of KH group was significantly lower than SF group and H group(P＜0.05);there was no statistical significance between SF group and H group(P＞0.05). There was no statistical significance in Ramsay score among 3 groups at different time points(P＞0.05). Before surgery,there was no statistical significance in HAD score or POMS score among 3 groups (P＞0.05). After surgery,HAD score and POMS score of KH group and H group were significantly lower than before surgery and SF group(P＜0.05);there was no statistical significance in KH group and H group,before and after surgery in SF group(P＞0.05). No vomiting,respiratory depression,pruritus and digestive tract bleeding were observed in 3 groups. The incidence of dizziness and nausea in H group and KH group were significantly lower than SF group (P＜0.05);there was no statistical significance between KH group and H group(P＞0.05). CONCLUSIONS:The flurbiprofen axetil combined with hydromorphone show good analgesic and sedative effect for PCIA after orthopedics operation,and can significantly improve emotion and mood of patients with good safety.
ABSTRACT
Objective To evaluate the efficacy of hydromorphone for postoperative parent-controlled intravenous analgesia in pediatric patients.Methods Seventy-five pediatric patients of both sexes,aged 2-5 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective surgery for treatment of developmental displasia of the hip,were divided into 2 groups using a random number table:sufentanil group (group S,n =38) and hydromorphone group (group H,n =37).Parent-controlled intravenous analgesia was carried out within 48 h after operation.Parent-controlled intravenous analgesia solution contained sufentanil 2 μg/kg (group S) or hydromorphone 200 μg/kg (group H) in 100 ml of normal saline.The analgesia pump was set up with a 0.5 ml bolus dose,a 15-min lockout interval and infusion at a rate of 0.5 ml/h.Ramsay sedation scores were recorded at 0.5,1,4,8,12,24 and 48 h after extubation (T1-7).At 1 h before operation (To),T3 and T6,blood samples were collected from the ulnar vein for determination of the concentration of substance P in serum.The total consumption of analgesics,the number of successfully delivered doses,the number of attempts and drug-related adverse reactions were recorded,and parents' satisfaction was scored.Results Compared with group S,Ramsay sedation scores were significantly decreased at T1-3,the number of attempts was increased (P＜0.05),and no significant change was found in the total consumption of analgesics,the number of successfully delivered doses,degree of parents' satisfaction,serum concentration of substance P or incidence of drug-related adverse reactions in group H (P＞0.05).Conclusion Hydromorphone can be safely and effectively used for postoperative parent-controlled intravenous analgesia in pediatric patients.
ABSTRACT
Objective To evaluate the role of δ-opioid receptors in hydromorphone postcondition-ing-induced maintenance of electrophysiological stability during ischemia-reperfusion(I∕R)in isolated rat hearts. Methods Healthy male Sprague-Dawley rats, aged 2-3 months, weighing 280-360 g, were used in this study. The animals were anesthetized with intraperitoneal pentobarbital 60 mg∕kg. Their hearts were immediately removed and perfused in a Langendorff apparatus. Thirty-two isolated hearts were divided into 4 groups after successful preparation of Langendorff perfusion model(n=8 each)using a random number ta-ble: control group(group C), group I∕R, hydromorphone postconditioning group(group HP)and hydro-morphone plus δ-opioid receptor antagonist naltridole postconditioning group(group HNP). In HP and HNP groups, the hearts were perfused for 10 min with K-H solution containing 41 ng∕ml hydromorphone and 41 ng∕ml hydromorphone plus 5 μmol∕L naltridole, respectively, and then with K-H solution for 50 min. At 20 min of stabilization(T0)and 10, 25 and 60 min of reperfusion(T1-2), heart rate(HR), monophasic action potential(MAP)duration at 90% repolarization(MAPD90)of the two layers(endocar-dium, epicardium)of the anterior left ventricular wall were recorded. Transmural dispersion of repolariza-tion(TDR)was calculated. The development of arrhythmia, time for restoration of spontaneous heart beat and duration of arrhythmia were recorded during the period of reperfusion. Results Compared with group C, MAPD90of endocardium at T1-2and MAPD90of epicardium at T1were significantly prolonged in I∕R and HP groups, HR was significantly decreased at T2-3, MAPD90of endocardium and epicardium was prolonged at T1-3in group HNP, TDR was significantly enlarged at T1in group I∕R and at T2in group HNP, and TDR was decreased at T3in group HP(P<005). Compared with group I∕R, no significant change was found in arrhythmia score(P>005), the time for restoration of spontaneous heart beat was significantly shortened, and TDR was decreased at T1in HP and HNP groups, duration of arrhythmia was significantly shortened, and MAPD90of endocardium was shortened at T1in group HP, and HR was significantly decreased at T2-3, MAPD90of endocardium and epicardium was prolonged at T1-3, and TDR was decreased at T2-3in group HNP(P<005). Compared with group HP, no significant change was found in time for restoration of spon-taneous heart beat, duration of arrhythmia or arrhythmia score(P>005), HR was significantly decreased at T2-3, MAPD90of endocardium and epicardium was prolonged at T1-3, and TDR was increased at T3in group HNP(P<005). Conclusion The mechanism underlying hydromorphone postconditioning-induced maintenance of electrophysiological stability during I∕R is related to activating δ-opioid receptors in isolated rat hearts.