Currently,
morphine and
fentanyl are the most commonly used intrathecal
opioids for the
postoperative pain management of patients who underwent cesarean delivery. Unfortunately, the
analgesic benefits of these 2 drugs tend to fall into different extremes based on
lipid solubility. Intrathecal
hydromorphone may provide more consistent
analgesia because its
lipid solubility falls between that of the other 2
opioids. A 22-year-old woman with a 39-week intrauterine pregnancy, gravida 2, para 1, came in for a scheduled second-time cesarean delivery. Her preoperative history included a
morphine allergy discovered when administered intrathecally during her first cesarean delivery. Thus, in this case, preservative-free
hydromorphone, 100 microg, was administered intrathecally as the
opioid replacement for the spinal
anesthetic. Intrathecal
hydromorphone was found to have provided superior
pain relief with fewer side effects in this patient, who received intrathecal
morphine for the same surgery 2 years earlier. This case report supports an emerging hypothesis that intrathecal
hydromorphone is not only safe but possibly more effective than other intrathecal
opioids for
pain management after cesarean delivery. The purpose of this case report is to encourage the development of more research regarding this use of intrathecal
hydromorphone.