A MULTIDIMENSIONAL COMPARISON OF MORPHINE AND HYDROMORPHONE PATIENT-CONTROLLED ANALGESIA

Although patient-controlled analgesia (PCA) pumps have been in use for more than a decade, the optimal PCA analgesic has yet to be identifie d. Many drugs are used; however, morphine remains the ''gold standard' ' of opioid analgesics worldwide. The present study evaluated morphine and hydromorphone (Dilaudid(R)) PCA with respect to analgesic efficac y, side effects, mood, and cognitive function. Sixty-one opioid naive patients undergoing lower abdominal surgery participated in the double -blind protocol. Verbal rating scores, use of medication, and side eff ects for the two medications were recorded. Cognitive functioning was assessed by computation of Digit Symbol and Trails Making B Tests. Sel f-reported affective state (mood) was measured by Profile of Mood Stat es (POMS) inventory. Both medications provided adequate analgesia with out a difference in side effects. Cognitive performance was poorer in the hydromorphone group (P < 0.05). Patients receiving hydromorphone r eported less anger/hostility (P < 0.01) and generally better mood elev ations on other subscales than those receiving morphine. A similar inc idence of side effects and dose of medication can be anticipated with morphine and hydromorphone. When considering cognitive effects, morphi ne had less adverse consequences, while hydromorphone appeared to resu lt in improved mood. We conclude that hydromorphone may provide a suit able alternative to morphine.