hydromorphone hydrochloride / Generic mfg. - LARVOL DELTA

A randomized trial of bupivacaine liposomal injectable suspension shows reduced need for postoperative analgesic rescue in dogs undergoing enucleation. (PubMed, J Am Vet Med Assoc) - "Dogs were premedicated with hydromorphone and acepromazine, induced with propofol, and maintained with isoflurane...Oral meloxicam was administered after the 8-hour time point...Treatment with BLIS reduced the need for rescue analgesia, and these dogs were more likely to have lower pain scores. BLIS may be useful as part of a multimodal pain management plan in dogs undergoing enucleation when administered as a peri-incisional eyelid block."

Journal • Pain

Trends of prenatal opioid utilization and neonatal abstinence syndrome in Manitoba, Canada: A 26-year population-based cohort study. (PubMed, Paediatr Child Health) - "We identified a decrease in codeine prescriptions during pregnancy and an increased number of prescriptions for more potent opioids (oxycodone, hydromorphone, morphine, and opioid agonist therapy). The incidence of NAS increased over the study period, in line with other jurisdictions. Further research is needed to study the safety of different opioid agonist therapies and multidisciplinary support needed to support parents to care for newborns with NAS in the postpartum period and beyond."

Journal • Pain • Substance Abuse

In Vitro Evaluation of the Co-Administration of Canine Blood Products and Drugs Used in Critical Illness. (PubMed, J Vet Emerg Crit Care (San Antonio)) - "Platelet function will likely be adversely affected by the co-administration of any of the selected drugs. Co-administration of ketamine, fentanyl, and midazolam with WB resulted in significant hemolysis and is not recommended. It is reasonable to consider co-administering ampicillin, TXA, and ketamine with FDP and FFP."

Journal • Preclinical • Hematological Disorders

Effect of transversus abdominis plane block versus intravenous hydromorphone on the quality of postoperative recovery in elderly critically Ill patients in the SICU: a single-center, single-blind, randomised controlled trial. (PubMed, Perioper Med (Lond)) - P=N/A | "TAP block significantly improves recovery quality and provides better analgesia than hydromorphone in elderly critically ill patients after major abdominal surgery, reducing opioid use and enhancing postoperative outcomes. It is a safe and effective alternative for pain management in the SICU."

Journal • Critical care • Pain

Comparative effects of fentanyl, morphine, and hydromorphone on postoperative delirium and outcomes after cardiac surgery: a propensity score-matched cohort study. (PubMed, Sci Rep) - "Hydromorphone was associated with a significantly lower incidence of POD, lower mortality, shorter length of stay, and more vasopressor- and ventilator-free days within 28 days. Whereas morphine was also associated with a reduced risk of delirium and shorter length of stay, it was not significantly associated with a reduction in mortality."

Journal • Cardiovascular • CNS Disorders • Critical care

Association between BDNF/CB1R expression and postoperative pain and recovery in patients with preoperative sleep disorders. (PubMed, BMC Anesthesiol) - "Preoperative sleep quality in TKA patients influences postoperative pain and recovery, with BDNF and CB1R levels partially mediating this effect."

Journal • Anesthesia • CNS Disorders • Orthopedics • Pain • Sleep Disorder • BDNF

Potential Factors Affecting Length of Stay in Patients Undergoing Stereotactic Electroencephalogram (AES 2025) - "Opiates were converted to oral morphine milligram equivalents (OMME) and directly compared to patient's LOS...Subgroup analyses did not find that a specific opiate (i.e. hydromorphone versus hydrocodone) contributed more to a prolonged LOS than another...Cenobamate was also noted to be held on post-operative day 0 in these patients... Data analysis indicates that prolonged LOS may be influenced by multiple factors, including quantity of opiates and ASMs with prolonged half-lives. Initially we thought that specific mechanisms of action of opiates may be an influencing factor, however our results have not contributed to that conclusion at this time. Our results also clearly show that a prolonged length of stay is indeed secondary to delay in seizure occurrence which may be a result of the aforementioned factors."

Clinical • CNS Disorders • Epilepsy

Esketamine prevents postoperative sleep disturbance in patients with preoperative sleep disorders: a role for oral microbiota. (PubMed, Transl Psychiatry) - "On POD 1, the esketamine group showed a significantly lower incidence of PSD (43.1 vs. 64.6%; OR, 0.414; P = 0.014) and reduced hydromorphone consumption. Preoperative oral microbiota profiles differed between patients with and without PSD, with specific bacterial taxa associated with sleep disturbance. These findings suggest that esketamine may alleviate postoperative sleep disruption, potentially through modulation of the oral microbiota."

Clinical • Journal • Anesthesia • CNS Disorders • Insomnia • Sleep Disorder

Cross-Fostering with control dams rescues Gut Dysbiosis and Chromatin-associated Transcriptional Changes in Offspring of Opioid-Exposed Dams. (PubMed, bioRxiv) - "Here using a murine model of prenatal hydromorphone exposure, we examined gut microbiota, intestinal injury, transcriptomic signatures, and chromatin accessibility...Fecal microbiota transplantation from exposed dams recapitulated intestinal injury, indicating a microbiome-driven mechanism. These findings reveal a novel gut-microbiome-epigenome axis underlying opioid-induced injury and highlight early microbial intervention as a potential strategy to mitigate developmental harm."

Journal • Transplantation

Comparison of dezocine and hydromorphone in post-cesarean epidural analgesia: a retrospective study. (PubMed, BMC Anesthesiol) - "Dezocine and hydromorphone demonstrated comparable analgesic effectiveness when administered via patient-controlled epidural analgesia (PCEA) following cesarean delivery. However, dezocine was associated with a significantly lower incidence of opioid-related adverse effects, indicating that it may serve as a safer and more tolerable alternative for postoperative pain management in obstetric patients."

Clinical • Journal • Retrospective data • Anesthesia • Dermatology • Obstetrics • Pain • Pruritus

Opioid-Induced Pruritus: A Case Series on Novel Uses of Nalbuphine in the Emergency Department. (PubMed, J Am Coll Emerg Physicians Open) - "Opioid-induced pruritus is a frequent and distressing adverse effect of mu-opioid receptor agonists, often unresponsive to antihistamines such as diphenhydramine...We present 2 cases highlighting nalbuphine's utility in the emergency department: one demonstrating prophylactic low-dose nalbuphine (2.5 mg IV) coadministered with hydromorphone in a pruritus-prone patient and one where nalbuphine (10 mg IV) served as a primary analgesic. In both cases, patients achieved pain relief without experiencing pruritus or sedation. These cases underscore nalbuphine's potential as a safe and evidence-informed alternative in acute care settings."

Journal • Anesthesia • Dermatology • Pain • Pruritus

Reliable variability in subjective responses to parenteral hydromorphone administration: empirical confirmation of an opioid non-responder phenotype. (PubMed, Neuropsychopharmacology) - "These findings confirm the presence of a "Opioid Non-Responder" phenotype for the first time in the context of a cumulative, parenteral dosing paradigm. Further research is warranted to elucidate the clinical implications and potential risk or protective factors underlying this phenotype."

Journal • Addiction (Opioid and Alcohol) • Pain • Substance Abuse

Efficacy and safety of hydromorphone for preemptive analgesia in patients undergoing laparoscopic cholecystectomy: a systematic review and meta-analysis. (PubMed, BMC Anesthesiol) - "The outcomes of this study substantiate the efficacy and safety of hydromorphone in the management of postoperative pain, demonstrating superiority over placebo or no treatment."

Clinical • Journal • Retrospective data • Review • Gastroenterology • Pain • CXCL8 • TNFA

Harnessing telemedicine to deliver patient-centered opioid agonist treatment within a community-based harm reduction service: a mixed methods evaluation. (PubMed, Harm Reduct J) - "Our community-based telemedicine program presents a novel framework for OAT delivery that efficiently bridges the health and community sectors. Working collaboratively around the patient, program partners leveraged their strengths to improve treatment experiences and promote retention."

Journal • Addiction (Opioid and Alcohol) • CNS Disorders • Human Immunodeficiency Virus • Infectious Disease • Novel Coronavirus Disease • Psychiatry • Substance Abuse

Drug and money choice preference patterns in regular heroin users maintained on buprenorphine (Neuroscience 2025) - "During experimental sessions, participants could choose across 12 trials between units of hydromorphone (HYD, 1 or 2 mg IM) and money ($2 or $4)...When predicting maximal effortful drug responding for a subset of subjects reserved for prediction (n=20), the regression model demonstrated acceptable fit (RMSE=0.32).ConclusionsOur results highlight that participants who initially choose opioid over a monetary alternative and exhibit faster decisional speed for opioid than money engaged in more effortful opioid-seeking. These findings suggest that higher-magnitude contingency management coupled with cognitive therapies that promote deliberation could decrease opioid use."

CNS Disorders • Substance Abuse

A Retrospective Analysis of Length of Stay in Postoperative Fracture Repair Patients Receiving Patient-Controlled Analgesia Versus Nurse-Administered Analgesia. (PubMed, Anesth Pain Med) - "Medications included in this study were morphine, oxycodone, hydromorphone, fentanyl, and acetaminophen. Patients in the PCA group had higher mean postoperative pain scores (μ = 4.92) compared to the NAA group (μ = 4.41), with a mean difference of 0.51 points (P = 0.046). This retrospective analysis suggests that the use of PCA in conjunction with NAA is associated with increased LOS and higher postoperative pain scores when compared to NAA alone in patients undergoing surgical repair of limb fractures."

Journal • Retrospective data • Musculoskeletal Diseases • Orthopedics • Pain

Associations between the Use of Pain Management Strategies and Self-Reported Emotional and Behavioral Functioning of Adolescent and Young Adults with Sickle Cell Disease (ASH 2023) - "These strategies were categorized as: Over the Counter Medication (acetaminophen, ibuprofen, naproxen), Prescription Medication (codeine, short-acting morphine, long-acting morphine, oxycodone, hydrocodone, hydromorphone, gabapentin, amitriptyline), Psychological Strategies (deep breathing, imagery, distraction, talking with friends/family, prayer/meditation), and Behavioral Strategies (hydrate, apply heat, apply cold, massage, smoking, rest/sleep). Results indicate that specific pain management strategies may be associated with different social, emotional, and behavioral functioning. Further exploration to understand the mechanisms between specific pain management strategies and patient functioning during the AYA period is warranted. Given the unique challenges of adolescents and young adults with SCD, future work should also investigate how specific pain management strategies may improve the experience of those transitioning from pediatric to adult care."

Clinical • Genetic Disorders • Hematological Disorders • Pain • Pediatrics • Sickle Cell Disease

Knowing the Dose to Control the Dose: Optimizing Patient-Controlled Analgesia in Adults with Sickle Cell Disease (SCD) (ASH 2023) - "Disease-modifying therapies prescribed included hydroxyurea (8/15, 53%), chronic transfusions (2/15, 13%), chronic transfusions plus hydroxyurea (1/15), voxelotor (1/15), no disease-modifying therapy (2/15)...The remainder of the patients were treated with a hydromorphone PCA pump with on-demand bolus dosing only, in addition to home long-acting oral opioids when applicable... Our data suggest that length of stay is shortened by ~4 days when clinicians quantify daily opioid use for patients on PCA. In addition, patients with frequent admissions tend to have higher inpatient daily opioid use. This hints that readmission may be partly driven by mild withdrawal when on outpatient opioids at lower MME."

Clinical • Addiction (Opioid and Alcohol) • Cardiovascular • Genetic Disorders • Hematological Disorders • Sickle Cell Disease • Thrombosis

Standardized Clinical Pathways Improve Management of Vaso-Occlusive Episodes in the Pediatric Emergency Department (ASH 2023) - "A total of 0 (0%) hydromorphone PCAs were administered in the ED in the pre-pathway cohort compared to 4 (3.8%) hydromorphone PCA administered in the ED in the post-pathway cohort... Standardizing pain management using a clinical pathway has shown improvement in ED management of VOE in the first year post implementation with increased utilization of intranasal fentanyl and PCAs. Our goal of increased percentage of patients receiving pain medication within 30 minutes and decreased time to first analgesic was not achieved, however this is an ongoing project and with education in implementation of the clinical pathway we hope to continue to see long term progress. Additionally, in the future, we plan to expand use of this pathway to additional sites within our health care system."

Clinical • Anesthesia • Genetic Disorders • Hematological Disorders • Pediatrics • Sickle Cell Disease

Pruritus in ESRD After Three Years on Thrice-Weekly Maintenance Hemodialysis: An Unusual and Unexpected Etiology (KIDNEY WEEK 2025) - "He was on hydromorphone for chronic pain from osteoarthritis and had spinal fusion in mid-2023, requiring more hydromorphone...Furthermore, the risk of transmission to other patients within the hemodialysis facility would represent a nightmare experience. Finally, the US Public Health System shuld be a lot more agile, responsive and proactive in tackling such cases."

Clinical • Chronic Kidney Disease • Dermatology • Diabetic Nephropathy • Immunology • Infectious Disease • Metabolic Disorders • Nephrology • Osteoarthritis • Pruritus • Renal Disease • Rheumatology

Refractory Hyponatremia in a Patient with Malignancy: A Role for Tolvaptan (KIDNEY WEEK 2025) - "She had decreased oral intake, fatigue, and a transient episode of unresponsiveness after taking her prescribed hydromorphone...She was given albumin and droxidopa for persistent low blood pressure and Nephrology was consulted for evaluation of persistent hyponatremia...The etiology of this patient’s hyponatremia is multifactorial including hypervolemia from hypoalbuminemia, non-osmotic ADH release from hypotension and sepsis, reduced solute intake and possible SIADH from malignancy. Tolvaptan was utilized because conventional management was challenged by contraindications."

Clinical • Cardiovascular • Fatigue • Gastroenterology • Genetic Disorders • Heart Failure • Hypotension • Infectious Disease • Nephrology • Oncology • Pancreatic Adenocarcinoma • Pancreatic Cancer • Pneumonia • Respiratory Diseases • Septic Shock

Buprenorphine Knowledge and Attitudes Among Sickle Cell Disease Providers (ASH 2024) - "When asked to compare buprenorphine's potency to other opioids, a small minority (9.8%, n=5) correctly rated buprenorphine as less potent than Fentanyl but more potent that hydromorphone, methadone, morphine and oxycodone, and a third reported not knowing about buprenorphine's potency compared to any of the aforementioned opioids (33.3%, n=17). Conclusion : In this survey of providers who care for patients with SCD, overall knowledge about buprenorphine's properties as a potent, effective opioid analgesic with fewer undesirable side-effects was low, but knowledge about its safety profile was high. Participants' low buprenorphine knowledge and comfort prescribing it highlights a continuing medical education opportunity that may help improve provider knowledge and comfort prescribing buprenorphine, and as a result, also improve pain management for SCD patients."

Addiction (Opioid and Alcohol) • CNS Disorders • Depression • Genetic Disorders • Hematological Disorders • Pediatrics • Psychiatry • Sickle Cell Disease • Substance Abuse

The Diagnostic and Therapeutic Challenge of Kratom Withdrawal: A Post-Transplant Case Managed with Methadone (ASRA-FALL 2025) - "Kratom (Mitragyna speciosa) is a plant with opioid properties and potential for tolerance and dependence due to the psychoactive alkaloids mitragynine and 7-hydroxymitragynine, the latter up to 13 times as potent as morphine [1]...There is limited evidence guiding the management of kratom withdrawal, though case reports have described using buprenorphine-naloxone, methadone, and clonidine to mitigate symptoms [2–3]...Postoperatively, she experienced severe right abdominal pain unrelieved by multimodal analgesia including erector spinae plane, external oblique and intercostal fascial plane blocks, ketamine infusion, and hydromorphone PCA...This patient presented as an acute pain consult due to challenging postoperative pain. Informed consent for submission of this report was obtained from the patient, and all de-identified information was acquired from chart analysis and patient interview, in accordance with Institutional Review Board requirements as per UT Health San..."

Clinical • Post-transplantation • Addiction (Opioid and Alcohol) • Anesthesia • Autoimmune Hepatitis • CNS Disorders • Gastrointestinal Disorder • Hepatology • Immunology • Inflammation • Insomnia • Musculoskeletal Pain • Psychiatry • Sleep Disorder • Transplantation

Transauricular Vagal Nerve Stimulation for Vaso-Occlusive Pain in Sickle Cell Disease: A Medically Complex Pediatric Case (ASRA-FALL 2025) - "METHODS • Patient: 18-year-old female patient with homozygous HbSS and recent acute chest syndrome was hospitalized with vaso- occlusive pain crisis refractory to hydromorphone and methadone. The results of this pilot experiment reveal that taVNS may be feasible, tolerable and effective in its use to combat VOC in patients suffering from sickle cell disease. It offers the promise of a safe, opioid-sparing adjunct that could be used in the outpatient or inpatient setting."

Clinical • Genetic Disorders • Hematological Disorders • Pain • Pediatrics • Sickle Cell Disease

Therapeutic Potential of Calcitonin Gene-related Peptide Antagonists in Spinal Cord Injury Related Neuropathic Pain: A Case Report (ASRA-FALL 2025) - "The patient was treated with scheduled acetaminophen, pregabalin, and duloxetine. Numerous opioid analgesic regimens were trialed (including oxycodone, tramadol, hydromorphone, and topical buprenorphine), either without significant analgesia or with significant sedation. Given the patient’s history of migraines, erenumab , a once monthly injectable CGRPi , was started."

Case report • Clinical • Anesthesia • CNS Disorders • Migraine • Musculoskeletal Diseases • Neuralgia • Orthopedics • Pain