ArticleFrontiers in medicine2026
Association of perineural hydromorphone added to ropivacaine with early analgesic outcomes in proximal humerus fracture surgery: a retrospective cohort study.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The analgesic benefit of adding perineural hydromorphone (HYD) to ropivacaine (ROP) for proximal humerus fracture surgery remains unclear. Objective: The aim of this study is to examine whether adding perineural hydromorphone to ropivacaine was associated with early analgesic outcomes and short-term adverse events. Methods: This single-center retrospective cohort included 130 consecutive eligible adults (ROP, Results: Analgesia success at 12 h occurred in 39/62 patients (62.9%) in the ROP + HYD group and 26/68 (38.2%) in the ROP group [absolute difference 24.7 percentage points, 95% confidence interval (CI) 7.5-39.9; unadjusted odds ratio (OR) 2.74, 95% CI 1.35-5.57; number needed to treat 4.1]. The adjusted OR was 3.72 (95% CI 1.66-8.77), and propensity score analyses gave similar estimates. A sensitivity model that also accounted for superficial cervical plexus and T2 paravertebral field supplementation gave an OR of 3.83 (95% CI 1.67-9.31). Mean VAS differences favored ROP + HYD at 6 h (-0.33, 95% CI -0.65 to -0.02) and 12 h (-0.58, 95% CI -0.86 to -0.29), but both were smaller than 1 point; no difference was detected at 24 h. Median total 24-h rescue opioid consumption was 4.8 morphine milligram equivalents (MME) with ROP + HYD and 6.4 MME with ROP ( Conclusions: Adding perineural hydromorphone was associated with a higher proportion of patients achieving resting VAS ≤3 at 12 h. The average VAS differences were modest and no difference was detected at 24 h. Because treatment was not randomized, these findings should be confirmed in a prospective trial.
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