HBOT Conversations:

In the United States the incidence of cesarean deliveries have increased over the last
several decades and is currently approximately 30% nationwide. The anesthesia and analgesia
for elective c-sections vary between institutions.

Parturients present a unique challenge for the anesthesiologist as the mother has to care not
only for herself, but also for the newborn postpartum. While intrathecal opioids provide
adequate pain relief, they do so at the cost of bothersome side effects for patients, such as
pruritus and nausea/vomiting.

Intrathecal hydromorphone has started to be explored as a new option for intrathecal
analgesia. A study done by Beatty et al. showed in a retrospective review that 40 mcg of
intrathecal dilaudid was safe and effective as compared to intrathecal morphine for analgesia
after cesarean delivery. Additionally they showed no difference in side effect profiles of
the two medications. Mhyre et al. investigated the use of 100 mcg of intrathecal dilaudid
with hyperbaric bupivacaine in varying dosages for labor analgesia. The results were
inconclusive, but the dosage of hydromorphone was reported to be without adverse effects.

Virginia Commonwealth University Health Systems has successfully instituted the use of
intrathecal morphine with superior analgesia but with undesired side effects, most notably
pruritus. Recent drug shortages of duramorph have prompted investigators to seek alternative
options for post cesarean section analgesia. The investigators are interested in determining
the dose, efficacy, and side effect profile of intrathecal hydromorphone. Although our
institution has never utilized intrathecal hydromorphone for our patient population, it has
been studied at various other institutions where it has been found to be safe and efficacious
with an acceptable side effect profile.