Objectives: The objective of this study was to evaluate the physical and chemical stability of hydromorphone hydrochloride and bupivacaine hydrochloride in concentrations of 15 mg.ml and 10 mg.mL in 0.9% sodium chloride injection. Test samples of hydromorphone/bupivacaine mixtures were stored at 37°C, body temperature encounterd during continuous intrathecal infusion, for 90 days. The solutions were packaged in 20 ml plastic syringes. Evaluations for physical and chemical stability were performed initially and throughout the storage periods. Physical stability was assessed by visual observation. The chemical stability of the drug was evaluated by means of a stability-indicating high-performance liquid chromatographic (HPLC) analytical technique. In addition, pH and osmolarity were measured electronically.
Methods: This study determines the stability and compatibility of hydromorphone (15 mg.ml) and bupivacaine (10 mg.ml) mixture after 3 months at 37°C using a validated method by HPLC-UV. A simple, precise, specific and accurate reversed phase high performance liquid chromatographic (RP-HPLC) method was developed and validated. The different analytical performance parameters such as linearity, accuracy, specificity, precision and sensitivity (limit of detection and limit of quantitation) were determined according to International Conference on Harmonisation ICH Q2 (R1) guidelines. RP-HPLC was conducted on a nucleoshell RP18plus (C18 150×4.6 mm with 2.7 µm particle size) column. The mobile phase consisted of buffer A (phosphate buffer (0.05M) pH 4.5) and acetonitrile B. The gradient used for the elution is the following one: time (min)/% of B: 0 min/20%; 1.9 min/50%; 2.5 min /40%; 4.5 min/40%; 5.5 min/20%; and 8 min /20%, and the flow rate was maintained at 1.0ml.min and performed at 35°C. The molecules were monitored using Dionex ultimate 3000, equipped with photo diode array detector (λ=210 nm). Linearity was observed in concentration range of 9-21 mg.l for hydromorphone and 6-14 mg.l for bupivacaine. All the system suitability parameters were found within the range.
Results: The degradation study shows a photolytic degradation compound for hydromorphone and an oxidative degradation compound found for bupivacaine. The stability study shows no visible haze or particulate formation or gas evolution. pH and osmolarity were stable during the 3 months. Colour changed after 2 months, although this colouring is due to hydromorphone, proportional to hydromorphone concentrations and increases with time but it is a well known modification. The quantitative study by HPLC method revealed no significant change in hydromorphone and bupivacaine concentration. There is less than 5% of variability during the 3-month period.
Conclusions: Hydromorphone (15 mg.ml) and bupivacaine (10 mg.ml) were physically and chemically compatible and analysed with HPLC, which revealed no significant change in hydromorphone and bupivacaine concentration in this simulated compatibility study.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043245 | PMC |
http://dx.doi.org/10.1136/ejhpharm-2018-001553 | DOI Listing |
Pain Physician
December 2024
Department of Anesthesiology, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ.
Background: Poorly controlled acute breast surgery postoperative pain is associated with delayed recovery, increased morbidity, impaired quality of life, and prolonged opioid use during and after hospitalization. Recently, ultrasound-guided pectoralis nerve (PECS) I block and serratus anterior plane (SAP) block, together or individually, have emerged as a potential method to relieve pain, decrease opioid requirements, and improve patient outcomes.
Objective: The aim of this study was to assess if the addition of a PECS I/SAP block in patients undergoing bilateral mastectomies provides more effective perioperative analgesia compared to standard analgesia.
Spine Deform
December 2024
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Purpose: Surgical treatments for adolescent idiopathic scoliosis (AIS) include posterior spinal fusion (PSF) and vertebral body tethering (VBT), but there is limited data that compares pain between these groups. We aimed to compare postoperative pain between these patients through inpatient opioid use and opioid prescriptions post-discharge.
Methods: A retrospective review of patients diagnosed with AIS who underwent PSF or VBT surgery was reviewed to determine LOS, inpatient opioid use, and opioids prescribed post-discharge.
Reg Anesth Pain Med
November 2024
Department of Anesthesiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
Background: Intrathecal drug delivery (IDD) is a well-established treatment modality for refractory chronic pain. Intrathecal catheter-tip granuloma (ICTG) formation is a known possible complication of opiate IDD and is likely triggered by mast cell degranulation. The use of low concentration and dosage of opioids that do not induce mast cell degranulation has been advised to mitigate the risk of ICTG formation.
View Article and Find Full Text PDFSpine Deform
January 2025
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Purpose: We aimed to determine if the use of intrathecal (IT) hydromorphone and/or liposomal bupivacaine (LB) decreased the amount of postoperative and post-discharge opioids for pediatric patients undergoing fusion (PSF) surgery to treat adolescent idiopathic scoliosis (AIS).
Methods: A retrospective review of AIS patients undergoing PSF surgery was conducted. Hospital LOS, and inpatient and post-discharge opioid use were compared.
Gynecol Oncol
November 2024
Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA; Robert D. and Patricia E. Kern Center for the Science of Healthcare Deliver, Mayo Clinic, Rochester, MN, USA. Electronic address:
Background: Enhanced recovery after surgery (ERAS) pathways utilize multimodal analgesia. In pathways already utilizing incisional injection of liposomal bupivacaine (ILB), we assessed the benefit of adding intrathecal opioid analgesia (ITA).
Methods: In this randomized controlled non-inferiority trial in patients undergoing laparotomy for gynecologic malignancy, we allocated patients 1:1 to ILB alone versus ITA + ILB with 150 μg intrathecal hydromorphone.
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