Intrathecal Hydromorphone Versus Intrathecal Morphine for Postcesarean Delivery Analgesia: A Randomized Noninferiority Trial
Primary result · 24-hour NRS pain scoreResult — go to the resultBetween-group difference −0.46 95% CI −1.0 to 0.1Authors' conclusion
Intrathecally, hydromorphone is noninferior to morphine for analgesia after elective cesarean delivery when using the previously established ED90 for both opioids (morphine: 150 µg versus hydromorphone: 75 µg); hydromorphone provides effective analgesia and may be a suitable alternative to morphine.
Study context
- Population
- Patients undergoing elective cesarean delivery under spinal anesthesia
- Participants
- 126 patients
- Comparison
- Intrathecal hydromorphone 75 µg vs morphine 150 µg
- Primary endpoint
- Between-group difference of mean Numeric Rating Scale (NRS) pain score (0-10) for first 24 h (single recall score at 24-h interview); noninferiority threshold 1
- Follow-up
- 24 hours
Methodological detailsnoninferiority, blinded
- Noninferiority
- Blinded
Primary result
24-hour NRS pain score
Between-group difference
−0.46
95% CI −1.0 to 0.1
By group
Morphine
4.0
mean · SD 1.7
Hydromorphone
3.6
mean · SD 1.5
Hydromorphone vs Morphine
between-group difference −0.46 (95% CI −1.0 to 0.1)
Non-inferiority margin 1 as printed, not drawn
As reported in the abstract
Secondary outcomes
24-h oral morphine consumption
P = 0.98
Time to first opioid request
P = 0.35
Median
| Outcome | Hydromorphone | Morphine | P value |
|---|---|---|---|
| ObsQoR-11 score | 90 (IQR 80–96.5) | 87 (IQR 75–97.5) | P = 0.51 |
Safety
| Outcome | Hydromorphone | Morphine | P value |
|---|---|---|---|
| Proportion requiring interventions for opioid-related pruritus | 0.321 (variance 0.218) | 0.316 (variance 0.216) | P = 0.96 |
| Proportion requiring interventions for opioid-related nausea and vomiting | 0.393 (variance 0.238) | 0.333 (variance 0.222) | P = 0.51 |
Original publication
Intrathecal Hydromorphone Versus Intrathecal Morphine for Postcesarean Delivery Analgesia: A Randomized Noninferiority Trial. Anesth Analg. Published 10 June 2025. doi:10.
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