Opioid analgesic
Hydromorphone
Dilaudid Opioid — blue 1 mg/mL (common)⚠ 2, 4, 10 mg/mL (high-potency)
Longer-acting opioid for end-of-case and PACU pain; about 5–7× morphine.
Typical adult doses
| Indication | Dose | Onset | Duration |
|---|---|---|---|
| PACU / end-of-case analgesia | 0.2–0.5 mg IV every 5–10 min, titrated | ≈5 min (peak 10–20) | 2–4 h |
Mechanism
Mu-opioid receptor agonist.
Key effects
- Analgesia
- Respiratory depression, sedation
- Nausea, pruritus
Watch out for
- High-potency concentrations are a known error source
- OSA and elderly: titrate slowly with monitoring
Reversal
Naloxone, titrated in 40 mcg increments.
Pimp questions
Pimp question
Other opioids you’ll hear — which is metabolized by nonspecific esterases?
Answer
Remifentanil: context-insensitive (≈3–4 min), so plan longer-acting analgesia before turning it off.