SU Xiawen 1 , HUANG Zhiran 1 , LIU Shiyang 1 , ZHI Mengjia 1 , GENG Shuai 2 , DIAO Yifan 1 , SUN Jing 1 , LIU Yuanli 1
  • 1. Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P.R.China;
  • 2. The 306th Hospital of PLA, Beijing, 100101, P.R.China;
SUN Jing, Email: sunjing@sph.pumc.edu.cn
Hydromorphone; Morphine; Cesarean section; Postoperative analgesia; Systematic review; meta-analysis; Efficacy; Safety; Randomized controlled trial
10.7507/1672-2531.201808004
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Objectives To systematically review the efficacy and safety of hydromorphone and morphine in post-cesarean section analgesia.Methods The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMbase, CNKI, WanFang Data, VIP and SinoMed databases were electronically searched to identify randomized controlled trials (RCTs) of hydromorphone vs. morphine in the treatment of postoperative analgesia after cesarean section from the inception of the database to December 2017. Two reviewers independently screened literatures, extracted data and assessed risk of bias of the included trials. The meta-analysis was conducted with RevMan 5.3 software.Results Seven trials with 586 post-cesarean section patients were included. The results of the meta-analysis showed that, compared with the morphine group, the hydromorphone group had lower 6 h (MD=–0.23, 95%CI –0.38 to –0.08, P=0.003), 12 h (MD=–0.56, 95%CI –1.10 to –0.02, P=0.04), 24 h (MD=–0.37, 95%CI –0.65 to –0.09, P=0.01) and 48 h (MD=–0.41, 95%CI –0.74 to –0.08, P=0.01) postoperative VAS scores the with epidural anesthesia pump (PECA). There was no statistically significant difference of the postoperative Ramsay scores between the two groups. In terms of side effects, the incidence of skin pruritus (RR=0.27, 95%CI 0.09 to 0.81. P=0.02) and vomit (RR=0.15, 95%CI 0.03 to 0.65, P=0.01) of the hydromorphone group were lower than those of the morphine group.Conclusions The current evidence demonstrate that, compared with morphine, hydromorphone has better postoperative analgesia performance and less risk of exhibiting skin pruritus and vomit after cesarean section. Considering of the overall quality of evidence and the relatively small pooled sample size, more well-conducted randomized controlled trials are required to verify the above conclusion.

Citation： SU Xiawen, HUANG Zhiran, LIU Shiyang, ZHI Mengjia, GENG Shuai, DIAO Yifan, SUN Jing, LIU Yuanli. Hydromorphone versus morphine in the treatment of postoperative analgesia after cesarean section: a systematic review. Chinese Journal of Evidence-Based Medicine, 2019, 19(2): 165-172. doi: 10.7507/1672-2531.201808004 Copy

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