University of Oulu

Puhto, T., Kokki, M., Hakomäki, H. et al. Single dose epidural hydromorphone in labour pain: maternal pharmacokinetics and neonatal exposure. Eur J Clin Pharmacol 76, 969–977 (2020).

Single dose epidural hydromorphone in labour pain : maternal pharmacokinetics and neonatal exposure

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Author: Puhto, Terhi1; Kokki, Merja2; Hakomäki, Henriikka3;
Organizations: 1Department of Anaesthesiology, Medical Research Center Oulu (MRC Oulu), Oulu University Hospital, PO Box 21, 90029, Oulu, Finland
2Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
3School of Pharmacy, University of Eastern Finland, Kuopio, Finland
4Forensic Toxicology Unit (THL), The Finnish Institute for Health and Welfare, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1 MB)
Persistent link:
Language: English
Published: Springer Nature, 2020
Publish Date: 2020-10-15


Introduction: Epidural hydromorphone could be useful in obstetric analgesia as there is a need for a more water-soluble opioid than sufentanil or fentanyl with prolonged analgesic effect. To our knowledge, the pharmacokinetics of epidural hydromorphone has not been evaluated in parturients.

Materials and methods: In this pilot study, seven healthy parturients were given a single epidural dose of hydromorphone for labour pain. One parturient received 1.5 mg, two 0.75 mg and four 0.5 mg of hydromorphone hydrochloride. Dose was decreased due to nausea and pruritus. Hydromorphone’s effect, adverse effects and plasma concentrations were evaluated. Neonatal drug exposure was evaluated by umbilical vein and artery opioid concentration at birth. Neonatal outcomes were assessed using Apgar and the Neurologic Adaptive Capacity Score (NACS).

Results: All patients received additional levobupivacaine doses on parturients’ requests. The first dose was requested at a median of 163 min (range 19–303 min) after hydromorphone administration. A total of 12 opioid related expected adverse events were reported by seven parturients. All newborn outcomes were uneventful. Hydromorphone’s distribution and elimination after single epidural dose seem similar to that reported for non-pregnant subjects after intravenous hydromorphone administration, but further research is required to confirm this observation.

Conclusions: The optimal dose of hydromorphone in labour pain warrants further evaluation.

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Series: European journal of clinical pharmacology
ISSN: 0031-6970
ISSN-E: 1432-1041
ISSN-L: 0031-6970
Volume: 76
Issue: 7
Pages: 969 - 977
DOI: 10.1007/s00228-020-02880-6
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
317 Pharmacy
Funding: Costs of laboratory analysis in this study have been supported by the Oulu medical Research Foundation (Oulu, Finland).
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