Intrathecal Hydromorphone for Pain Control After Cesarean Section

The use of intrathecal opioids for analgesia in the setting of cesarean section has become
standard obstetric anesthesia practice. Currently, two opioids are commonly used. These
opioids are fentanyl and morphine (Duramorph). Intrathecal opioids are an excellent source of
analgesia and act to reduce the stress response to surgery.

Currently, most obstetric anesthesiologists use intrathecal morphine for analgesia after
cesarean delivery. Morphine provides excellent analgesia for cesarean section. However, use
of this medication is associated with side effects such as pruritus and nausea and vomiting.

Recently, multiple obstetric anesthesia groups began to use intrathecal hydromorphone for
cesarean delivery when morphine was unavailable. As groups began to use hydromorphone,
retrospective data became available that demonstrated its safety and efficacy for use during
cesarean section.

In order to fully elucidate the analgesic and side effect properties of hydromorphone for
cesarean delivery, a prospective randomized, double blind study comparing morphine and
hydromorphone is necessary. The investigators need to understand whether hydromorphone is as
effective as morphine for analgesia after cesarean section, and whether it is associated with
fewer or more side effects. The results of the study will allow providers to make educated
decisions to better care for their patient.