Epidural/Intrathecal Dilaudid

[DreamLover]

So another one of my hospitals has become the victim to drug shortages....

No Preservative free morphine left in the building

I've not used dilaudid much epidurally (Only to dose some of my thoracic epidurals) and never in a lumbar/labor epidural and I have never given it intrathecally

Any opinions on a difference in effect from duramorph to dilaudid?

I don't even have enough experience with epidural/spinal dilaudid to know good equivalent doses to attempt. I'm curious what works for you??

If I were to give 4-5mg duramorph via CLE, clinically...do people see similar effects at .5-1mg Dilaudid?

How about for 250mcg of intrathecal duramorph? I don't have a good guess for effective intrathecal dilaudid with the lowest side-effect profile I can get....any ideas?

The search I did didn't reveal any good comparisons between the two

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[ssmallz]

http://www.asaabstracts.com/strands...E58DD1624BCBE3?year=2002&index=10&absnum=1022

seems reasonable

 

[Planktonmd]

We have switched to Dilaudid for both intrathecal and epidural analgesia more than 2 years ago.
The results are very encouraging and I don't think we will go back to Morphine.
We have better pain control and significantly less nausea and itching.
Our doses are:
0.1 mg intrathecal
1 mg Epidural
In the European literature they used much smaller doses but our doses seem to be effective and safe.

So another one of my hospitals has become the victim to drug shortages....

No Preservative free morphine left in the building

I've not used dilaudid much epidurally (Only to dose some of my thoracic epidurals) and never in a lumbar/labor epidural and I have never given it intrathecally

Any opinions on a difference in effect from duramorph to dilaudid?

I don't even have enough experience with epidural/spinal dilaudid to know good equivalent doses to attempt. I'm curious what works for you??

If I were to give 4-5mg duramorph via CLE, clinically...do people see similar effects at .5-1mg Dilaudid?

How about for 250mcg of intrathecal duramorph? I don't have a good guess for effective intrathecal dilaudid with the lowest side-effect profile I can get....any ideas?

The search I did didn't reveal any good comparisons between the two

 

[PinchandBurn]

We have switched to Dilaudid for both intrathecal and epidural analgesia more than 2 years ago.
The results are very encouraging and I don't think we will go back to Morphine.
We have better pain control and significantly less nausea and itching.
Our doses are:
0.1 mg intrathecal
1 mg Epidural
In the European literature they used much smaller doses but our doses seem to be effective and safe.

1mg epidural? Isnt that a lot?

 

[PMPMD]

So another one of my hospitals has become the victim to drug shortages....

No Preservative free morphine left in the building

I've not used dilaudid much epidurally (Only to dose some of my thoracic epidurals) and never in a lumbar/labor epidural and I have never given it intrathecally

Any opinions on a difference in effect from duramorph to dilaudid?

I don't even have enough experience with epidural/spinal dilaudid to know good equivalent doses to attempt. I'm curious what works for you??

If I were to give 4-5mg duramorph via CLE, clinically...do people see similar effects at .5-1mg Dilaudid?

How about for 250mcg of intrathecal duramorph? I don't have a good guess for effective intrathecal dilaudid with the lowest side-effect profile I can get....any ideas?

The search I did didn't reveal any good comparisons between the two

I think hydromorphone is more intermediate in lipid solubility vs morphine. One of our pain docs used it in his IT pumps. I don't have any experience with regular OR use of it as an SAB adjunct.

 

[Planktonmd]

1mg epidural? Isnt that a lot?

No It's not, based on our 2 year experience

 

[Idiopathic]

1mg epidural? Isnt that a lot?

it is until it isnt. probably about 2x what i would do, but i dont have much experience with it