Single dose epidural hydromorphone in labour pain: maternal pharmacokinetics and neonatal exposure

Terhi Puhto,Teemu Gunnar,Merja Kokki,Merja Vakkala,Michael Spalding,Seppo Alahuhta,Henriikka Hakomäki

doi:10.1007/s00228-020-02880-6

Abstract

IntroductionEpidural hydromorphone could be useful in obstetric analgesia as there is a need for a more water-soluble opioid than sufentanil or fentanyl with prolonged analgesic effect. To our knowledge, the pharmacokinetics of epidural hydromorphone has not been evaluated in parturients.Materials and methodsIn this pilot study, seven healthy parturients were given a single epidural dose of hydromorphone for labour pain. One parturient received 1.5 mg, two 0.75 mg and four 0.5 mg of hydromorphone hydrochloride. Dose was decreased due to nausea and pruritus. Hydromorphone’s effect, adverse effects and plasma concentrations were evaluated. Neonatal drug exposure was evaluated by umbilical vein and artery opioid concentration at birth. Neonatal outcomes were assessed using Apgar and the Neurologic Adaptive Capacity Score (NACS).ResultsAll patients received additional levobupivacaine doses on parturients’ requests. The first dose was requested at a median of 163 min (range 19–303 min) after hydromorphone administration. A total of 12 opioid related expected adverse events were reported by seven parturients. All newborn outcomes were uneventful. Hydromorphone’s distribution and elimination after single epidural dose seem similar to that reported for non-pregnant subjects after intravenous hydromorphone administration, but further research is required to confirm this observation.ConclusionsThe optimal dose of hydromorphone in labour pain warrants further evaluation.

Highlights

Epidural hydromorphone could be useful in obstetric analgesia as there is a need for a more water-soluble opioid than sufentanil or fentanyl with prolonged analgesic effect
As the actual sampling times were used in the pharmacokinetic calculations, it was considered unlikely that these deviations affected the results
In the present study of labouring women, after epidural HM administration the median elimination half-life of 162 min seven parturients plotted against time after epidural administration of 0.5–1.5 mg of hydromorphone. b–h Individual hydromorphone plasma concentrations, NRSs, times of birth and levobupivacaine administrations plotted against time from study participants ID 1–7

Summary

Introduction

Epidural hydromorphone could be useful in obstetric analgesia as there is a need for a more water-soluble opioid than sufentanil or fentanyl with prolonged analgesic effect. The pharmacokinetics of epidural hydromorphone has not been evaluated in parturients. Materials and methods In this pilot study, seven healthy parturients were given a single epidural dose of hydromorphone for labour pain. Hydromorphone’s effect, adverse effects and plasma concentrations were evaluated. Neonatal drug exposure was evaluated by umbilical vein and artery opioid concentration at birth. Results All patients received additional levobupivacaine doses on parturients’ requests. The first dose was requested at a median of 163 min (range 19–303 min) after hydromorphone administration. A total of 12 opioid related expected adverse events were reported by seven parturients. Hydromorphone’s distribution and elimination after single epidural dose seem similar to that reported for non-pregnant subjects after intravenous hydromorphone administration, but further research is required to confirm this observation

Methods

Results

Conclusion