Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
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Which is a Better Pain Medicine After Surgery: Morphine or Dilaudid?
Posted in Chronic Pain by Dr. Sharon Orrange on Mar 08, 2012
Whether its knee replacement, lumbar spine surgery, or hysterectomy; most of the anxiety my patients have about their upcoming surgery is about pain they will have after surgery, and potential nausea and vomiting from their pain meds. Patient controlled analgesia (PCA) is often used after surgery where patients press a button to deliver their intravenous pain medications. The pain medicine delivered by PCA is usually either Morphine or Dilaudid (Hydromorphone.) Many healthcare providers believe Dilaudid causes less nausea than Morphine but until recently that had not been studied.

Does treatment with Dilaudid (hydromorphone) result in improved pain control and fewer adverse side effects than morphine for postoperative pain? It doesn’t look like it. Evidence shows that when it comes to nausea, pruritus (itching,) vomiting, sedation, pain, and patient satisfaction, the side effect profile was not different between the two drugs. The incidence of nausea did not differ between morphine and hydromorphone treated patients nor was there a difference in the amount of pain or in patient satisfaction.

The choice between morphine and hydromorphone, for postoperative pain, can be a discussion you have with your surgeon before surgery but it appears there isn’t much difference between the two.

What has your experience been?

- Dr. O.

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24
I've found that Dilaudid was more effective post-operative than Morphine if in the right dosage. Morphine has a tendency to make me a bit nauseated, where the Dilaudid did not. For some reason I have an extremely high drug tolerance, (Most Any Drug)and what might knock someone else out for a week, feels like baby aspirin to me. It's not due to continued use for pain management. Can you explain what causes that? Is it genetic, or to do with Metabolism, ect. I.ve always wondered why I need high doses of any drug, and what it means. Thanks.
By Triniti  May 07, 2013
23
MORPHINE BY FAR!! THE OTHER LEFT ME WITH A HEAD ACHE THAT WAS WORSE THAN WHAT I WENT TO ER FOR.
By ANGELINKNOTS  Apr 08, 2013
22
All opiods make me nauseous, and I usually need zofran. But to me, the effects of dilaudid seem to last longer than morphine, meaning I need to use less medication. Anyone find this?
By churinl  Jun 25, 2012
21
after my most recent surgery, a colon resection and removal of an ovary, i was given a Dilaudid pump. i didn't have much pain, usually about a 4 or 5 out of 10 on the likert scale so i didn't use it much. i didn't have any side effects. i was however given morphine at the ed for severe pain - which btw i did not have but the rn insisted - and that was ugly. although i was given zofran to counteract the nausea it didn't work and i was ill. so, given a choice i'd choose Dilaudid for the first few hours post op.
By ThePeople  Apr 16, 2012
20
I prefer AND had good results with Morphine after surgery. No bad side effects.
By energylost  Mar 13, 2012
19
One of the major differences between Morphine and Dilaudid is their potency. This means the strength of pain control per objective milligram dosing. For example 5mg of Intraveous Morphine is about equivalent to about 0.75 to 1mg of Dilaudid. BOTH drugs are JUST AS EFFECTIVE IN CONTROLLING PAIN, One is NOT better than the other. But the physician must remember to give equivalent pain control dosings. The problem that may arise is that perhaps 5mg of Intravenous Morphine is given first but does NOT control the pain completely, the patent then asks for something else. The physician then orders 2mg of Intravenous Dilaudid (equivalent to 12+ mg of Morphine) because s/he wants to give a higher dose and just approximates the conversion ratios. The patient gets relief and thinks Dilaudid is the miracle pain medicine that worked. When in reality either one would have worked just as well. The Morphine just should have been given in a higher dose.
By edcheung  Mar 12, 2012
18
As a hospitalist for over 18 years (first one in my group in the entire state back then), I have used both. There really is not much of a difference clinically that I have noticed. If one does not seem to control things well or causes side effects, then switch to the other after a few doses.

The real key to controlling the post operative pain is the timing and amount of pain medicine delivered. The PCA pump really is one of the best options out there and really should be the standard after major surgery unless an epidural pain block is in. Whether you use Morphine or Dilaudid, it just depends on which one you may nave taken and tolerated before. If neither, then go with one and you can always discuss changing in a day if not well controlled or side effects.
By edcheung  Mar 12, 2012
17
This is good.
By pallavivm  Mar 12, 2012
16
very good
By mustafa123  Mar 12, 2012
15
Morphine always made me vomit. An anesthesiologist told me that was common with women, and that women, in general, did better with Fentanyl. It does seem to work better for me and without the nausea.
By Ministrmom83  Mar 11, 2012
14
I was never impressed with that do-it-yourself pain control that they give you right after surgery. I had the impression that they watered it down so you couldn't possibly OD. It never did much for the pain, either. Morphine doesn't do much for pain either - it just gives you such a head rush you don't care as much about the pain. But it does make me terribly nauseated. I don't know what else they gave me (in tablet form) after various surgeries, but I had very impressive pain control. I'm not sure when - or if - I've had Dilaudid.
By madbookworm  Mar 10, 2012
13
after a DVT in my left leg ( second DVT, other was in right leg 3 years prior) I was in intense pain, and when my portacath tube was pulled out of my vein I was crying and screaming for something and dilauded was bollused and given and it almost completely killed the pain in less than a minute. With my other blood clot the nurse did a dressing change with the vaccum bandage and that hurt unbelievably. They gave me morphine for that ( I don't know what dose) and it helped a lot but was not even close to the effectiveness of the other pain killer.
By orangemonkeyee  Mar 10, 2012
12
I've had everything in a hospital setting. I've had 7 major surgeries and will have more to try and prolong my life. If we are just comparing Morphine & Hydro/Dilaudid. Morphine definately is far less effective and from my experience and study it can cause peoples head to explode. Opioids in general increase intercranial pressure and can cause these symptoms but in my experience Dilaudid is way more effective. About 2mg of Dilaudid is about 10mg of morphine. That's probably not exact but just based on experience. I'd rather get a little more Dilaudid for my extreme pain after surgery than a ton of morphine especially with all the anesthesia coming out of your system.Point being Dilaudid takes less to do more with less side effects overall.
By xmaddog24  Mar 10, 2012
11
I've had everything in a hospital setting. I've had 7 major surgeries and will have more to try and prolong my life. If we are just comparing Morphine & Hydro/Dilaudid. Morphine definately is far less effective and from my experience and study it can cause peoples head to explode. Opioids in general increase intercranial pressure and can cause these symptoms but in my experience Dilaudid is way more effective. About 2mg of Dilaudid is about 10mg of morphine. That's probably not exact but just based on experience. I'd rather get a little more Dilaudid for my extreme pain after surgery than a ton of morphine especially with all the anesthesia coming out of your system.Point being Dilaudid takes less to do more with less side effects overall.
By xmaddog24  Mar 10, 2012
10
I have had both during surgeries and I learned the hard way that Morphine is NOT for me I had terrible allergic reactions to it but the next surgery I was given Dilaudid and it worked perfect. So from my experience there is a BIG difference
By CindyinLancaster  Mar 10, 2012
9
I had both for pulmonary emboli. My experience is that when the nurse shoots it into my IV in a hurry - nausea is guaranteed. When I complained, I was given an anti-nausea injection to minimize the discomfort.

I noticed that with injections by one late night nurse, who was not in a hurry and took about 2 minutes to complete the injection, I suffered zero nausea. She explained that the directions, which every nurse (even those in a hurry) are required to read, are specific in directing SLOW administration.

After that, I instructed each of my nurses to take 2 minutes to deliver the injection, and just like magic, I never experienced nausea again. I preferred the Dilaudid.
By WFCoyote  Mar 10, 2012
8
Post Surgical Not Duroesic or Fentanyl, Except first 4 hours as lozenges, re;1000mg sr.fentanyl loz., not patches or paient control.
methadone , with somethings for nausea-rotine. methadne plus mprhine (ordine-syrup) when pain wins the war.

hydromorphne ,not sr.or patient sontrol. lozenge, routine vs rest; yes I belive oral hydromorph would be effetive immedially, less nausa, Big Study...........................Jessica
By hydromorphed  Mar 10, 2012
7
Sorry for the comment X2
By ladykj64  Mar 10, 2012
6
Personally, morphine makes my head want to explode so i prefer dilaudid. I received it after my hernia op. and it worked great with no side effects to speak of.
By ladykj64  Mar 10, 2012
5
Personally, morphine makes my head want to explode so i prefer dilaudid. I received it after my hernia op. and it worked great with no side effects to speak of.
By ladykj64  Mar 10, 2012

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