Comparison of Side Effects of Morphine and Hydromorphone Patient-Controlled Analgesia (PCA)

• Mean Score on the Numeric Rating Scare (NRS) Pruritus Scale [ Time Frame: 1 hour after surgery, 8 hours after surgery ] [ Designated as safety issue: No ]
  The NRS Pruritus Scale was used to measure magnitude of pruritus (0 = none, 10 = the worst).
• Pain Assessment by Patient [ Time Frame: 1 hour after surgery, 8 hours after surgery ] [ Designated as safety issue: No ]
  Numeric Rating Scale for Pain: (0 = none, 10 = the worst), ordinal.
• The Number of Patients Who Vomited [ Time Frame: 1 hour after surgery, 8 hours after surgery ] [ Designated as safety issue: No ]
• Mean Score on the Ramsey Scale of Sedation [ Time Frame: 1 hour after surgery, 8 hours after surgery ] [ Designated as safety issue: No ]
  The Ramsey scale is used as a measure of sedation from 1 (the patient in anxious and agitated) to 6 (the patient exhibits no response).

Both morphine and hydromorphone are pain medications commonly used after surgery. It is thought at our institution that hydromorphone causes less side effects but this has not been studied. We propose to treat our patients with either morphine or hydromorphone and determine how much nausea, vomiting, and itching they have with each drug

Patients having general surgery at Columbia University Medical Center that will require Patient-Controlled Analgesia Inclusion: 18-60. American Society of Anesthesiologists (ASA) 1-2 Exclusion, pregnancy, lactation, chronic pain or opioids prior to surgery

• Drug: Morphine PCA
  Morphine 1mg/mL, dose 1mL, lockout 6 minutes, max 10mL
  Other Names:

  • Astramorph PF
  • Duramorph
  • Infumorph
• Drug: Hydromorphone PCA
  hydromorphone PCA 0.2mg/lml, dose 1ml, lockout 6min, max 10ml
  Other Name: Dilaudid

• Active Comparator: A
  Patients receive morphine 1mg/dose PCA for postsurgical pain; max 10 mg/hr; lockout 6 minutes.
  Intervention: Drug: Morphine PCA
• Active Comparator: B
  Patients receive hydromorphone 0.2mg/dose PCA for postsurgical pain; max 10mg/hr; lockout 6 minutes.
  Intervention: Drug: Hydromorphone PCA

Inclusion Criteria:

• patients scheduled for abdominal surgery requiring post-operative PCA
• ASA = I or II

Exclusion Criteria:

• preoperative pain or use of pain medication
• narcotic allergy
• morbid obesity (Body Mass Index > 30)
• diagnosis of sleep apnea
• hepatic or renal disease
• use of medications that would affect narcotic pharmacodynamics
• preoperative nausea, vomiting, or pruritis
• diagnosis of alcoholism