Comparison of dezocine and hydromorphone in post-cesarean epidural analgesia: a retrospective study.

BACKGROUND: Postoperative pain management following cesarean delivery is essential for optimizing maternal recovery and reducing complications. Patient-controlled epidural analgesia (PCEA) is widely used; however, the choice of opioid remains debated due to variations in effectiveness and side effect profiles. This study aims to compare the analgesic effectiveness and adverse effects of dezocine and hydromorphone in PCEA regimens for cesarean delivery. METHODS: In this retrospective study, 1,582 parturients who underwent cesarean delivery under neuraxial anesthesia and received postoperative PCEA between March 2019 and July 2022 were reviewed. 755 patients received dezocine (Group D) and 827 received hydromorphone (Group H). All patients received 250 mg ropivacaine compounded with either 10 mg dezocine or 4 mg hydromorphone, diluted to 250 ml. Primary outcomes included analgesic effectiveness (assessed via VAS scores, PCEA bolus frequency, and rescue analgesia rates) and adverse effects (nausea/vomiting, pruritus, lower limb numbness and motor block). RESULTS: Baseline demographic characteristics were comparable between groups (P > 0.05). Both groups showed comparable analgesic effectiveness with no significant differences in VAS scores (P = 0.29), PCEA bolus usage (P = 0.36), or need for rescue analgesia (P = 0.18). However, Group D experienced significantly fewer adverse effects. The incidence of nausea/vomiting was 16.9% in Group D vs. 28.1% in Group H (P < 0.001), and pruritus occurred in 12.3% vs. 24.8% (P < 0.001), respectively. No significant difference was observed in the incidence of lower limb numbness (P = 0.33) or motor block as assessed by Bromage score(P = 0.41). CONCLUSIONS: 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.