Retrospective Comparison of Epidural and Intrathecal Hydromorphone Analgesia for Hysterectomy and Cytoreductive Surgery

IntroductionEpidural analgesia is widely used for postoperative analgesia in patients undergoing gynecologic surgeries, but the use of intrathecal hydromorphone has been largely unexplored in this patient population.This retrospective comparative effectiveness study evaluated intrathecal hydromorphone versus thoracic epidural analgesia (TEA) in patients undergoing open gynecologic surgery.The primary endpoints were length of hospital stay, ability to participate in physical therapy, and requirement of fluid boluses to maintain normotension.Secondary endpoints included postoperative pain scores at 12, 24, 48, and 72 hours; opioid consumption (reported in morphine milligram equivalents, or MME) at 24, 48, and 72 hours; and postoperative nausea and vomiting (PONV). MethodsWe analyzed retrospective data after implementing the use of intrathecal hydromorphone in females > 18 years old undergoing hysterectomy and cytoreductive surgery at our institution.We compared these data to a similar cohort that received epidural analgesia. ResultsThe intrathecal hydromorphone group had significantly lower pain scores at 12 hours post-surgery compared to the epidural group (mean 3.57 ± 2.43 vs. 5.35 ± 2.92; p = 0.029) and a significantly shorter length of hospital stay (mean 60.65 ± 26.83 hours vs. 86.26± 39.26 hours; p = 0.013).Physical therapy participation and fluid bolus requirements were comparable between groups.Pain scores at 24, 48, and 72 hours, overall opioid consumption, and rates of PONV did not differ significantly between the groups. ConclusionLiterature on intrathecal opioid use in gynecologic oncologic surgery remains limited, particularly regarding intrathecal hydromorphone.This study demonstrates the feasibility of intrathecal hydromorphone as an analgesic strategy in this population, with associated reductions in length of hospital stay and comparable pain control relative to epidural analgesia.These findings support intrathecal hydromorphone as a promising and feasible alternative to epidural analgesia, warranting further investigation in prospective, randomized controlled trials.