An amazing thing happened at work last week: the hospital ran out of Dilaudid. Add that to the fact that we were out of Morphine and Ketamine and our options for managing pain were dwindling. So much so that patients with legitimate sickle cell crises had to sign out to go to a nearby hospital for some type of pain control.
Thankfully, we still have Dolobid (we once had a provider who got so tired of patients asking for Dilaudid, that he started promising them he would give them exactly what they wanted. “Sure, I’ll order some Dolobid [rhymes with Dilaudid] for you”…amazingly most people’s pain improved, until the nursing supervisor caught wind of what was happening and we all received an email to no longer prescribe the NSAID Dolobid).
Anyhow, a journal article published in the November 2017 issue of Neurology looked at both quick and sustained headache relief when using IV Dilaudid vs IV Benadryl + Compazine. While the end-result was not surprising (spoiler alert: Dilaudid loses), the amount by which Benadryl+Compazine was superior was eye-opening. 60% relief compared to 31%, forcing researchers to stop the study early.
This was a randomized, double-blinded study with 127 patients who received either 10mg IV Compazine+ 25mg IV Benadryl or 1mg IV Dilaudid. The primary outcome was a headache level of “mild or none” within 2 hours of medication and maintenance of that level for 48 hours without rescue medication.
Aside from lower rates of headache relief, patients in the Dilaudid group also had a longer length of stay by over 80 minutes and were more likely to request a second dose of analgesia.
Reference:
Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine. Neurology. 2017 Nov 14;89(20):2075-2082.
