Low-Dose Epidural Hydromorphone as an Adjunct to Ropivacaine for Intraoperative Visceral Traction Pain During Elective Cesarean Delivery: A Randomized, Double-Blind, Placebo-Controlled Trial.
Yi Zhang, Qingjun Zeng, Haishan Cui et al.
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From the abstract
Visceral traction during cesarean delivery may cause pain, nausea, and autonomic activation despite an adequate neuraxial block. We evaluated whether adding 0.3 mg epidural hydromorphone to ropivacaine altered patient-reported pain and clinically relevant traction responses across predefined perioperative phases.
Reported results
All 96 women completed the trial. The longitudinal pain analysis showed a group-by-time interaction (Greenhouse-Geisser corrected p=0.008; participant-level randomization-based permutation p=0.009). At the post-registration focal comparison during abdominal exploration, median (IQR) VAS was 1.65 (0.70-2.60) with hydromorphone and 1.90 (0.78-3.92) with saline (nominal Mann-Whitney p=0.039).
Authors' conclusions
Low-dose epidural hydromorphone added to ropivacaine was associated with a different longitudinal pain profile and fewer episodes of intraoperative nausea or vomiting during elective cesarean delivery. Post hoc pain-distribution and exploratory physiological findings require prospective confirmation.