• Vikas O'Reilly-Shah and Grant C Lynde.
• Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA, 30322, USA.
• BMC Anesthesiol. 2018 Oct 5; 18 (1): 140.

BackgroundWith the increasing occurrence of drug shortages, understanding the pharmacokinetics of alternative intrathecal opioid administration has gained importance. In particular, additional data are needed to comprehensively evaluate the analgesic properties of intrathecal hydromorphone in the laboring patient. In a phase 2 clinical trial, we set out to determine the median effective dose (ED50) and time to effectiveness for this drug in this population.MethodsUsing Dixon's up-and-down sequential allocation method, twenty women presenting for labor analgesia were prospectively enrolled. A combined spinal-epidural technique was used to deliver the determined dose of intrathecal hydromorphone. Visual analog pain scores were obtained assessing peak pain scores during serial uterine contractions. Effective pain relief was defined as achieving a pain score of less than or equal to 3 out of 10. The dose was deemed to be ineffective if the patient failed to achieve this level of relief after 30 min.ResultsThe ED50 of hydromorphone in our population was 10.9 μg (95% confidence interval 5.6-16.2 μg). Amongst patients for whom the dose was effective, the median time to pain relief was 24 min. One patient experienced both nausea and pruritus. No other complications were noted.ConclusionDue to the prolonged time to onset, hydromorphone cannot be recommended in favor of substantively better alternatives such as sufentanil and fentanyl.Trial RegistrationClinicaltrials.gov registration number: NCT01598506.

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