Hydromorphone <i>versus</i> morphine in the treatment of postoperative analgesia after cesarean section: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

SU Xiawen ¹ , HUANG Zhiran ¹ , LIU Shiyang ¹ , ZHI Mengjia ¹ , GENG Shuai ² , DIAO Yifan ¹ ,  SUN Jing ¹ , LIU Yuanli ¹

1. Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P.R.China;
2. The 306^th Hospital of PLA, Beijing, 100101, P.R.China;

Corresponding?author：

SUN Jing, Email: sunjing@sph.pumc.edu.cn

Keywords：

Hydromorphone; Morphine; Cesarean section; Postoperative analgesia; Systematic review; meta-analysis; Efficacy; Safety; Randomized controlled trial

DOI：

10.7507/1672-2531.201808004

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objectives To systematically review the efficacy and safety of hydromorphone and morphine in post-cesarean section analgesia.Methods The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMbase, CNKI, WanFang Data, VIP and SinoMed databases were electronically searched to identify randomized controlled trials (RCTs) of hydromorphone vs. morphine in the treatment of postoperative analgesia after cesarean section from the inception of the database to December 2017. Two reviewers independently screened literatures, extracted data and assessed risk of bias of the included trials. The meta-analysis was conducted with RevMan 5.3 software.Results Seven trials with 586 post-cesarean section patients were included. The results of the meta-analysis showed that, compared with the morphine group, the hydromorphone group had lower 6 h (MD=–0.23, 95%CI –0.38 to –0.08, P=0.003), 12 h (MD=–0.56, 95%CI –1.10 to –0.02, P=0.04), 24 h (MD=–0.37, 95%CI –0.65 to –0.09, P=0.01) and 48 h (MD=–0.41, 95%CI –0.74 to –0.08, P=0.01) postoperative VAS scores the with epidural anesthesia pump (PECA). There was no statistically significant difference of the postoperative Ramsay scores between the two groups. In terms of side effects, the incidence of skin pruritus (RR=0.27, 95%CI 0.09 to 0.81. P=0.02) and vomit (RR=0.15, 95%CI 0.03 to 0.65, P=0.01) of the hydromorphone group were lower than those of the morphine group.Conclusions The current evidence demonstrate that, compared with morphine, hydromorphone has better postoperative analgesia performance and less risk of exhibiting skin pruritus and vomit after cesarean section. Considering of the overall quality of evidence and the relatively small pooled sample size, more well-conducted randomized controlled trials are required to verify the above conclusion.

Citation： SU Xiawen, HUANG Zhiran, LIU Shiyang, ZHI Mengjia, GENG Shuai, DIAO Yifan, SUN Jing, LIU Yuanli. Hydromorphone versus morphine in the treatment of postoperative analgesia after cesarean section: a systematic review. Chinese Journal of Evidence-Based Medicine, 2019, 19(2): 165-172. doi: 10.7507/1672-2531.201808004 Copy

1.	Ginsberg JS, Chan WS, Bates SM, et al. Anticoagulation of pregnant women with mechanical heart valves. Medicina Clínica, 2003, 121(19): 755.
2.	周據津. 納布啡與舒芬太尼用于剖宮產術后鎮痛臨床效果的比較. 鄭州: 鄭州大學, 2017.
3.	馮娟, 汪超, 李湘蓮, 等. 剖宮產術后鎮痛研究進展. 現代醫藥衛生, 2015, 31(20): 3111-3113.
4.	李中華, 蘭麗霞. 氫嗎啡酮用于剖宮產術后硬膜外持續鎮痛的臨床效果和不良反應觀察. 中國基層醫藥, 2017, 24(10): 1571-1574.
5.	王麗娟, 樊晉榮. 鹽酸氫嗎啡酮用于剖宮產術后硬膜外鎮痛的臨床觀察. 中國醫藥指南, 2017, 15(28): 60.
6.	吳亞南. 氫嗎啡酮用于產科術后鎮痛的臨床觀察. 現代醫學與健康研究電子雜志, 2017, 1(4): 85-86.
7.	蔣軍, 黃瓊艷. 鹽酸氫嗎啡酮在剖宮產術后自控鎮痛中的應用. 臨床合理用藥雜志, 2016, 9(31): 60-61.
8.	謝海森, 林曉剛, 王曉麗. 鹽酸氫嗎啡酮硬膜外單次注射聯合靜脈自控鎮痛在剖宮產術后的應用. 現代醫院, 2015, 15(2): 45-47.
9.	陳遠輝, 唐啟鵬, 孫燕飛, 等. 氫嗎啡酮和嗎啡用于剖宮產術硬膜外鎮痛的效果比較分析. 中國婦幼保健, 2015, 30(6): 970-971.
10.	嚴國勝, 楊明乾, 劉會長, 等. 氫嗎啡酮單次給藥用于剖宮產術后硬膜外鎮痛的臨床觀察. 醫學新知雜志, 2014, 24(3): 175-177.
11.	Kumar P, Sunkaraneni S, Sirohi S, et al. Hydromorphone efficacy and treatment protocol impact on tolerance and mu-opioid receptor regulation. Eur J Pharmacol, 2008, 597(3): 39-45.
12.	Felden L, Walter C, Harder S, et al. Comparative clinical effects of hydromorphone and morphine: a meta-analysis. Brit J Anaesth, 2011, 107(3): 319-328.
13.	張紅衛, 吳靜. 國內外剖宮產研究現狀分析. 中華現代護理雜志, 2015, 21(18): 2229-2232.

1. Ginsberg JS, Chan WS, Bates SM, et al. Anticoagulation of pregnant women with mechanical heart valves. Medicina Clínica, 2003, 121(19): 755.
2. 周據津. 納布啡與舒芬太尼用于剖宮產術后鎮痛臨床效果的比較. 鄭州: 鄭州大學, 2017.
3. 馮娟, 汪超, 李湘蓮, 等. 剖宮產術后鎮痛研究進展. 現代醫藥衛生, 2015, 31(20): 3111-3113.
4. 李中華, 蘭麗霞. 氫嗎啡酮用于剖宮產術后硬膜外持續鎮痛的臨床效果和不良反應觀察. 中國基層醫藥, 2017, 24(10): 1571-1574.
5. 王麗娟, 樊晉榮. 鹽酸氫嗎啡酮用于剖宮產術后硬膜外鎮痛的臨床觀察. 中國醫藥指南, 2017, 15(28): 60.
6. 吳亞南. 氫嗎啡酮用于產科術后鎮痛的臨床觀察. 現代醫學與健康研究電子雜志, 2017, 1(4): 85-86.
7. 蔣軍, 黃瓊艷. 鹽酸氫嗎啡酮在剖宮產術后自控鎮痛中的應用. 臨床合理用藥雜志, 2016, 9(31): 60-61.
8. 謝海森, 林曉剛, 王曉麗. 鹽酸氫嗎啡酮硬膜外單次注射聯合靜脈自控鎮痛在剖宮產術后的應用. 現代醫院, 2015, 15(2): 45-47.
9. 陳遠輝, 唐啟鵬, 孫燕飛, 等. 氫嗎啡酮和嗎啡用于剖宮產術硬膜外鎮痛的效果比較分析. 中國婦幼保健, 2015, 30(6): 970-971.
10. 嚴國勝, 楊明乾, 劉會長, 等. 氫嗎啡酮單次給藥用于剖宮產術后硬膜外鎮痛的臨床觀察. 醫學新知雜志, 2014, 24(3): 175-177.
11. Kumar P, Sunkaraneni S, Sirohi S, et al. Hydromorphone efficacy and treatment protocol impact on tolerance and mu-opioid receptor regulation. Eur J Pharmacol, 2008, 597(3): 39-45.
12. Felden L, Walter C, Harder S, et al. Comparative clinical effects of hydromorphone and morphine: a meta-analysis. Brit J Anaesth, 2011, 107(3): 319-328.
13. 張紅衛, 吳靜. 國內外剖宮產研究現狀分析. 中華現代護理雜志, 2015, 21(18): 2229-2232.

Chinese Journal of Evidence-Based Medicine

Hydromorphone versus morphine in the treatment of postoperative analgesia after cesarean section: a systematic review

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content