Anti-Hydromorphone polyclonal antibody

Objective: The goal of this study was to investigate and compare the effects and safety of the epidural injection of different doses of hydromorphone hydrochloride on postoperative analgesia after cesarean section. Methods: A total of 150 full-term singleton primiparas who underwent cesarean section under combined spinal-epidural anesthesia (CSEA) were enrolled and randomly divided into group A, group B, and group C according to a random number table, with 50 parturients in each group. At the end of the operation, parturients in the three groups were connected with an epidural catheter and a disposable analgesic syringe pump for postoperative analgesia. The analgesic pump configurations in the groups A, B and C were respectively as follows: 2 mg, 4 mg and 6 mg hydromorphone hydrochloride + 238.4 mg ropivacaine. The visual analogue scale (VAS), numeric rating scale (NRS), Ramsay sedation scale (RSS) and incidence of postoperative adverse reactions were recorded at the 1st, 3rd, 6th, 12th, 24th and 48th hour after operation. Results: Parturients in the group C had significantly lower VAS and NRS scores than those in the groups A and B at the 1st, 3rd, 6th, 12th and 24th hour after operation, and those in the group B had lower VAS and NRS scores than those in the group A (all P<0.05). Parturients in the group C had significantly higher RSS score than those in the groups A and B, and those in the group B had higher RSS score than those in the group A (P<0.05). There was no statistically significant difference in adverse reactions between the three groups (P>0.05). Conclusion: Epidural injection of different doses of hydromorphone hydrochloride has a good analgesic effect in the early stage after cesarean section, of which 6 mg hydromorphone hydrochloride is more effective.

In light of the current opioid epidemic, the medical community is exploring potential means to reduce postoperative narcotic use. This retrospective cohort study aimed to assess the impact of a gynecologic oncology enhanced recovery after surgery (ERAS) pathway on postoperative need for narcotics in the first 3 months after an open surgery in patients with ovarian cancer. Both cohorts included subjects recruited at the University of Washington, where an ERAS pathway for gynecologic oncology was implemented May 1, 2016. The control cohort included patients with ovarian cancer undergoing surgery in 2014 prior, whereas the second cohort included patients treated following the implementation of the ERAS pathway. Patients in the ERAS pathway received counseling on postoperative multimodal pain treatment with an emphasis on early mobility as well as acetaminophen and gabapentin preoperatively. At the conclusion of the surgery, patients in the ERAS cohort received fascial and subdermal long-acting liposomal bupivacaine, scheduled acetaminophen and ketorolac for 24 hours, followed by scheduled ibuprofen, and were given oral oxycodone or hydromorphone for narcotic pain management. The Washington State Prescription Monitoring Program was used to determine the number of narcotic prescriptions subjects filled in the 3 months postoperatively. A total of 42 patients underwent open surgery for ovarian cancer in 2014 (pre-ERAS), whereas 94 underwent open surgery on the ERAS pathway (ERAS). Patients on the ERAS pathway spent an average of 2.5 fewer days in the hospital with no difference in readmission. Compared with the pre-ERAS, the ERAS patients used less narcotics in the 24 hours before discharge (74.0 MME vs 25.8 MME, respectively, P = 0.002), filled prescriptions for lower MME quantity at discharge (519.9 MME vs 339.7 MME, respectively, P = 0.011), and filled fewer additional narcotic prescriptions after discharge (52.4% vs 29.4%, respectively, P = 0.012). The ERAS cohort filled prescriptions for 55% less MME compared with the pre-ERAS cohort in the 3 months postoperatively (492.1 MME vs 1101.4 MME, respectively, P < 0.001). This study demonstrated a reduction in narcotic use in the 24 hours before discharge and 3 months postoperatively for patients receiving open surgery for ovarian cancer with pain management directed under an ERAS pathway.