Hydromorphone in labor epidural infusion

[foshizzo]

Anyone using hydromorphone instead of fentanyl in their labor epidural infusions. I recall that in 2002, the Yale group published promising results with 0.05% bupivacaine with 3
g/mL hydromorphone infused at a rate of 10 –14 mL/h. Don't know if they are still using hydromorphone, or if anyone else is as well... thoughts?


http://news.yale.edu/2002/05/16/dru...without-uncomfortable-numbness-yale-study-sho

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[epidural man]

Anyone using hydromorphone instead of fentanyl in their labor epidural infusions. I recall that in 2002, the Yale group published promising results with 0.05% bupivacaine with 3 g/mL hydromorphone infused at a rate of 10 –14 mL/h. Don't know if they are still using hydromorphone, or if anyone else is as well... thoughts?


http://news.yale.edu/2002/05/16/dru...without-uncomfortable-numbness-yale-study-sho

In general hydromorphone is a better neuraxial opioid then morphine or fentanyl, probably sufenta as well.

However, on the labor deck, it probably doesn't matter that much - and that is why you will get everyone perseverating about how their concoction is much better than yours. I think there are plenty of those threads that can be found on here.

Opioids in the neuraxis act different depending on wether they are bolused, or infused - meaning their analgesic properties behave different depending on delivery. Some give band analgesia with infusions, some mostly give systemic analgesia - and the same applies with bolus dosing.

Then unwanted side effects come into play as well (think respiratory depression).

Again, most of this I think washes out on the labor deck so it doesn't really matter. Has anyone ever heard of a women in active labor having severe respiratory depression from an epidural (without systemically delivered opioids)?

 

[narcusprince]

3gm/ml sure seems like a ton of Dilaudid. I have heard good things about hydromorphone in Neuraxial blocks.

 

[foshizzo]

3gm/ml sure seems like a ton of Dilaudid. I have heard good things about hydromorphone in Neuraxial blocks.

Narcusprince thanks for pointing out the typo: I meant to write 3 mcg/ml hydromorphone, mixed in with dilute bupivacaine.

As epidural man alluded to, the thought is that more hydrophilic opioids like hydromorphone will provide a greater degree of spinal analgesia when given as an infusion, whereas the typical 2mcg/ml fentanyl labor epidural infusion given at 8-12 ml/hr will mostly get absorbed by the vaculature and end up primarily providing supraspinal (systemic) analgesia.

That being said, I haven't heard of any centers using hydromorphone in their labor epidurals, with the possible exception of Yale.

 

[diceksox]

I was a resident at Yale and they do indeed still use dilaudid in their epidural bags. It seems to work fine, not so sure it is any better or worse than fentanyl.

 

[foshizzo]

I was a resident at Yale and they do indeed still use dilaudid in their epidural bags. It seems to work fine, not so sure it is any better or worse than fentanyl.

diceksox do you remember what concentration of local and hydromorphone Yale uses in their bags? also, when you did CSE's, did you use hydromorphone for those as well? how much? thanks!

 

[Idiopathic]

we do it for our thoracic epidurals but still use fentanyl for oue labor epidurals.

 

[WholeLottaGame7]

We use hydromorphone at 10mcg/ml w/ or w/o local depending on the type of case, surgeon, etc. Usually for thoracics. On L&D we use fentanyl.