A Multidimensional Comparison of Morphine and Hydromorphone Patient-Controlled Analgesia

Abstract

Comment: The search for an ideal narcotic for the treatment of acute postoperative pain with a patient-controlled analgesia (PCA) pump continues. This study concluded that hydromorphone is a viable alternative to morphine in this situation. The authors' advantage point for using hydromorphone was that patients reported less anger/hostility and generally had better mood elevation while using PCA with hydromorphone compared with morphine. When treating the patient with acute postoperative pain, the clinical significance of this finding is questionable. Despite the fact that the authors state there are no statistical differences in physiologic side effects between the hydromorphone and morphine groups, the incidence on postoperative day 1 of nausea, vomiting, and headache are all higher for the hydromorphone group. In fact, the incidence of headache is almost doubled for the hydromorphone group. It would be interesting to see more long-term data regarding these important variables. The increase in cost of hydromorphone PCA alone probably does not justify its routine use at most institutions. Perhaps hydromorphone is better suited for the treatment of chronic pain, especially that involving malignancy. In this scenario, an improvement in mood and energy level, as suggested by this study, is of clinical significance and an active goal of the pain management team.