Intrathecal Hydromorphone for Pain Control After Cesarean Section

Phase 2

Completed

Brief Summary: 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.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Intrathecal hydromorphone	Intrathecal hydromorphone	50mcg intrathecal hydromorphone added to 1.5 mg 0.75% bupivicaine for single shot spinal anesthesia in primary cesarean sections.
Intrathecal morphine	Intrathecal morphine	0.25mg ( 250mcg) intrathecal morphine added to 1.5 mg 0.75% bupivicaine for single shot spinal anesthesia in primary cesarean sections

Primary Outcome Measures

Name	Time	Method
Post Operative Fentanyl PCA Consumption	at 24 hours	Total dose of fentanyl patient controlled analgesia (pca) used in 24 hours post-op.

Secondary Outcome Measures

Name	Time	Method
Patient Satisfaction Score	at 24 hours	Patient satisfaction score - total scale of 1-5, with higher score indicating more satisfaction
Symptom Scale for Two Specific Side Effects of Nausea and Pruritus	up to 24 hours	Symptom scale for nausea and pruritus. Full scale from 1-5, with higher score indicating more symptoms.
Time to Initial PCA Use	up to 24 hours	When does the patient need to use the PCA for the first time? This will be used to assess when morphine and hydromorphone first begin to provide analgesia.
Pain Score	at 24 hours	Assess pain scores on a scale of 1-5, with higher score indicating more pain.