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You plan for spinal anesthesia with intrathecal Duramorph, but the patient claims an allergy to morphine. The “allergy” stems from a past episode of nausea and vomiting, when the patient received intravenous morphine. If you use Duramorph and the patient suffers from PONV, guess who will be blamed? And in today’s legal climate one can never be too careful.
Intrathecal hydromorphone is an excellent substitute for Duramorph. Anecdotally, is has fewer side effects than Duramorph, but it is not a panacea by any means. The duration of action is about 2/3 of intrathecal morphine. A dose of 0.15-0.2mg is adequate and well tolerated even in the geriatric population.
A word of warning: Hydromorphone is available in both 1 and 2 mg/ml preparations. There have been incidents where this was not appreciated, which required a detour to the ICU with a naloxone drip.
Pa'san Ridge Trail - photo by JoAnn Sturman
