Rodieux Frédérique, Ivanyuk Anton, Besson Marie, Desmeules Jules, Samer Caroline F
Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland.
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Front Pediatr. 2022 Apr 25;10:842454. doi: 10.3389/fped.2022.842454. eCollection 2022.
While morphine is the gold standard treatment for severe nociceptive pain in children, hydromorphone is increasingly prescribed in this population. This review aims to assess available knowledge about hydromorphone and explore the evidence for its safe and effective prescription in children. Hydromorphone is an opioid analgesic similar to morphine structurally and in its pharmacokinetic and pharmacodynamic properties but 5-7 times more potent. Pediatric pharmacokinetic and pharmacodynamic data on hydromorphone are sorely lacking; they are non-existent in children younger than 6 months of age and for oral administration. The current data do not support any advantage of hydromorphone over morphine, both in terms of efficacy and safety in children. Morphine should remain the treatment of choice for moderate and severe nociceptive pain in children and hydromorphone should be reserved as alternative treatment. Because of the important difference in potency, all strategies should be taken to avoid inadvertent administration of hydromorphone when morphine is intended.
虽然吗啡是治疗儿童重度伤害性疼痛的金标准药物，但氢吗啡酮在该人群中的处方量越来越大。本综述旨在评估关于氢吗啡酮的现有知识，并探讨其在儿童中安全有效处方的证据。氢吗啡酮是一种阿片类镇痛药，在结构、药代动力学和药效学特性上与吗啡相似，但效力强5至7倍。关于氢吗啡酮的儿科药代动力学和药效学数据严重缺乏；6个月以下儿童以及口服给药方面的数据不存在。目前的数据在儿童的疗效和安全性方面均不支持氢吗啡酮优于吗啡。吗啡应仍然是儿童中度和重度伤害性疼痛的首选治疗药物，氢吗啡酮应留作替代治疗。由于效力存在重要差异，当使用吗啡时应采取一切策略避免意外给予氢吗啡酮。
