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Intrathecal hydromorphone for analgesia after partial hepatectomy: a randomized controlled trial
  1. Lin Ding1,
  2. Dongxu Chen1,
  3. Yu Chen2,
  4. Xiongli Wei3,
  5. Yabing Zhang1,
  6. Fei Liu1 and
  7. Qian Li1
  1. 1Department of Anesthesiology, West China Hospital of Medicine, Chengdu, Sichuan, China
  2. 2Department of Anesthesiology, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, Sichuan, China
  3. 3Department of Anesthesiology, Liuzhou Worker's Hospital, Liuzhou, Guangxi, China
  1. Correspondence to Dr Qian Li, Department of Anesthesiology, West China Hospital of Medicine, Chengdu, 610041 PR, China; hxliqian{at}


Introduction There is substantial interest in adding intrathecal opioids, such as hydromorphone to the multimodal pain management strategies. We conducted a randomized controlled trial to examine whether adding intrathecal hydromorphone to a multimodal strategy could safely improve analgesic efficacy for patients undergoing partial hepatectomy.

Methods A total of 126 adult patients undergoing partial hepatectomy under general anesthesia were randomly assigned to receive intrathecal hydromorphone (100 μg) or no block. The primary outcome was the incidence of moderate to severe pain during movement at 24 hours after surgery. Secondary outcomes included the incidence of moderate to severe pain during rest or movement at different times within 72 hours, pain scores during rest or movement within 72 hours after surgery, analgesic use, adverse events, and indicators of postoperative recovery.

Results Among the 124 patients analyzed, the intrathecal hydromorphone group showed a lower incidence of moderate to severe pain during movement at 24 hours after surgery (29.0% vs 50%; RR 0.58, 95% CI 0.37 to 0.92) than the control group. However, the absolute difference in pain scores on a numerical rating scale was less than 1 between the two groups at 24 hours after surgery. Mild pruritus within the first 24 hours after surgery was more frequent in the intrathecal hydromorphone group (19.4% vs 4.8%; p=0.01).

Discussion Intrathecal hydromorphone 100 μg reduced the incidence of moderate to severe pain and pain scores during movement within 24 hours after partial hepatectomy. However, the difference in pain scores may not be clinically significant, and intrathecal hydromorphone 100 μg did not significantly improve other analgesic or functional outcomes. Further investigation is needed to optimize the intrathecal hydromorphone dose.

Trial registration number ChiCTR2000030652.

  • Pain Management
  • Acute Pain
  • Injections, Spinal

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • LD and DC contributed equally.

  • Correction notice This article has been corrected since it published Online First. The contributor statement has been updated.

  • Contributors LD and DC helped with topic selection, literature search, study design, data curation and analysis and manuscript preparation. LD and DC contributed equally to this manuscript. YC, XW and YZ helped with study design and execution, data acquisition, curation and analysis. FL is a co-corresponding author. FL and QL helped with topic selection, literature search, study design and execution, validation and supervision of projects, manuscript preparation and revision. QL acts as the guarantor for this manuscript and accepts full responsibility for the conduct of the study and the results. This author had full access to the data and made the final decision to publish.

  • Funding This work was supported by the '1.3.5 Project for Disciplines of Excellence-Clinical Research Incubation Project' of West China Hospital, Sichuan University (grant 2018HXFH025 and ZYGD20005).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.