Intravenous hydromorphone has been acknowledged as an effective alternative for IV fentanyl in complex outpatient and ambulatory extended recovery cases, according to an Aug. 25 report from Anesthesiology News.
A team from Memorial Sloan Kettering Cancer Center, based in New York City, conducted a two-year project that analyzed outpatient procedures at a freestanding ambulatory cancer surgery center. Comprising 13,287 patients, the study, which was driven by a nationwide shortage of preloaded fentanyl syringes, was the largest analysis comparing the effects of both first-line opioid analgesics.
Patients who underwent outpatient procedures from April 15, 2019, to May 17, 2021, were given fentanyl, and patients who underwent outpatient procedures from May 18 to Dec. 28, 2021, were given hydromorphone. The most prominent difference between the two groups was an increased length of stay of about 18 minutes for the patients who received hydromorphone. Additionally, these patients were 0.48 percent more at risk for re-surgery, but the overall rates of re-surgery were low.
"Our disciplinary team concluded that while analysis of outpatient cases revealed slightly longer postoperative stays, the benefits of decreased time and waste of prefilled IV hydromorphone outweighed the slightly longer length of stay," Geema Shetty Masson, MD, an associate attending anesthesiologist at Memorial Sloan Kettering Cancer Center, said in the report. "IV hydromorphone can be safely used in a first-line opiate analgesic in a freestanding surgical center despite its slower onset and longer duration."
The results were presented at the 2023 annual meeting of the Society for Ambulatory Anesthesia, according to the report.