Epidural Hydromorphone for Postpartum Pain Management After Vaginal Delivery: A Randomized Clinical Trial

<b>ABSTRACT</b><b>Background</b> Mothers frequently experience differing intensities of postpartum analgesia following vaginal delivery; however, there remains a deficiency of effective and readily available modalities for postpartum pain management. This study aims to assess the analgesic efficacy and safety profile of epidural hydromorphone in the treatment of postpartum pain.<b>Methods </b>This randomized controlled trial enrolled 460 full-term women who had a full-term vaginal delivery. The participants received either epidural hydromorphone (HY group) or normal saline (NS group). The primary outcome was pain scores within 48 hours postpartum, with the occurrence of adverse events systematically documented.<b>Results</b> Within 48 hours post-treatment, median pain scores were significantly lower in HY group compared to NS group (P &lt; 0.001). The proportion of mothers with postpartum pain scores ≤3 was significantly higher in the HY group than in the NS group (76.47% vs. 27.93%; OR 2.81, 95% CI 2.24-3.53). Postpartum analgesic medication requirements were reduced in the HY group (6.79% vs. 24.77%; OR 0.39, 95% CI 0.25-0.61), and the time to first additional analgesic was prolonged (15.63 ± 5.98 vs. 12.01 ± 5.01 h). However, the HY group exhibited increased rates of nausea and vomiting (26.24% vs. 8.11%; RR 1.72, 95% CI 1.45-2.04), dizziness (25.34% vs. 14.41%; RR 1.34, 95% CI 1.13-1.66), pruritus (32.58% vs. 7.21%; RR 1.95, 95% CI 1.67-2.28), and urinary retention (20.81% vs. 7.66%; RR 1.59, 95% CI 1.32-1.91). Conversely, the incidence of sleep disturbances was lower in the HY group (5.43% vs. 30.18%; RR 0.27, 95% CI 0.16-0.45). The HY group demonstrated improved early bedside mobility (76.02% vs. 64.41%) and overall satisfaction (89.59% vs. 63.51%). Postpartum inflammatory markers, including leukocyte count (13.53 ± 3.26 vs. 13.91 ± 3.20) and ultrasensitive C-reactive protein levels (62.69 ± 38.00 vs. 65.93 ± 36.20), were lower in the HY group, although these differences did not reach statistical significance.<b>Conclusions</b> Epidural hydromorphone effectively reduced postpartum pain, with manageable side effects. Clinicians should balance the benefits and potential risks when considering postpartum analgesia.<b>Key Points</b><b>Question</b>In women post-vaginal delivery, does the administration of epidural hydromorphone offer superior analgesia and enhance maternal satisfaction relative to a placebo (normal saline)?<br><b>Findings</b>Epidural hydromorphone demonstrated a statistically significant reduction in postpartum pain scores, a decreased requirement for supplemental analgesics, and enhanced maternal satisfaction. Observed adverse effects included nausea, dizziness, pruritus, and urinary retention, all of which were deemed manageable.<br><b>Meaning</b>Epidural hydromorphone presents as a viable analgesic modality for the management of postpartum pain following vaginal delivery, offering effective pain relief within an acceptable safety profile.<br>