Is Hydromorphone PCA Safer Than Morphine PCA?

Jonathan Roth, MD

To the Editor

Concerning respiratory depression with patient controlled analgesia (PCA),1 there is reason to suspect hydromorphone may be inherently safer. Hydromorphone has a more rapid and complete penetrance to the central nervous system. Hence, peak effect occurs in about 10 minutes. With morphine and its metabolites, you may achieve 70% of its peak effect in 10 minutes, but the peak effect may not occur for up to 90 minutes. Hence, if you titrate to effect with 10 minute lockouts, with morphine, you are setting up for a delayed overdosage, but not with hydromorphone. Has there been a study comparing the safety of hydromorphone (Dilaudid) vs. morphine PCA?

Jonathan Roth, MD
Philadelphia, PA


Reference

  1. Stoelting RK. Dangers of postoperative opioids—Is there a cure? APSF Newsletter 2009:24(2);25-6.