{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T06:15:34Z","timestamp":1783664134036,"version":"3.55.0"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cesarean delivery often causes significant postoperative pain, which can affect recovery and increase the risk of chronic pain and prolonged opioid use. This study compared commonly used hydromorphone and sufentanil regarding postoperative outcomes after cesarean delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This multi-center retrospective cohort study, conducted across multiple centers in China between June 2022 and June 2025, included patients undergoing elective cesarean sections who received patient-controlled analgesia (PCA) with either hydromorphone or sufentanil. Postoperative pain, measured by the numerical rating scale (NRS), was the primary outcome. Secondary outcomes included use of rescue opioid use, incidence of postoperative nausea and vomiting (PONV), and hospitalization costs. Propensity score matching (PSM) was used to balance baseline characteristics, and regression models were applied to compare primary and secondary outcomes between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      Among 10,608 eligible patients, PSM yielded 2,682 matched pairs with good covariate balance. After matching, median NRS scores on day 1 were 4 [3\u20135] in sufentanil group, 4 [4\u20135] in hydromorphone group; on day 3, the score was 3 [2\u20133] in both groups. Matched pair-aware analyses showed no significant between-group differences in pain (day 1 mean difference 0.002, 95% CI \u22120.056 to 0.060,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.945; day 3 mean difference 0.001, 95% CI \u22120.047 to 0.049,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.960). Observed PONV was lower with sufentanil (4.88% vs. 7.38%,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), but this was not statistically significant in matched pair-aware analysis (OR 0.815, 95% CI 0.235\u20132.830,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.747). Rescue opioid use also did not differ significantly (OR 0.564, 95% CI 0.081\u20133.932,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.563). Costs (in Renminbi) were lower with sufentanil in matched analyses: total cost mean difference \u2212125.481 (95% CI \u2212193.189 to \u221257.773), anesthesia cost \u221282.107 (95% CI \u221286.245 to \u221277.969), and PCA cost \u221282.218 (95% CI \u221285.298 to \u221279.138), all\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Hydromorphone and sufentanil provided comparable postoperative analgesia after elective cesarean section. Sufentanil was associated with lower analgesia-related and total costs, while differences in PONV and rescue opioid use were not statistically significant in matched pair-aware analyses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1834000","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:38:07Z","timestamp":1783661887000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison between sufentanil and hydromorphone for postoperative analgesia after cesarean section: a propensity-score matched analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Hui","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Hanzhong Central Hospital, Hanzhong","place":["Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weigang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Hanzhong Central Hospital, Hanzhong","place":["Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Beijing Anzhen Nanchong Hospital of Capital Medical University, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong","place":["Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Hanzhong Central Hospital, Hanzhong","place":["Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e208","DOI":"10.1097\/AOG.0000000000003132","article-title":"ACOG practice bulletin no. 209: obstetric analgesia and anesthesia.","volume":"133","year":"2019","journal-title":"Obstet Gynecol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1186\/s12871-016-0270-6","article-title":"Prevalence and risk factors for chronic pain following cesarean section: a prospective study.","volume":"16","author":"Jin","year":"2016","journal-title":"BMC Anesthesiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2287","DOI":"10.2147\/JPR.S144066","article-title":"Poorly controlled postoperative pain: prevalence, consequences, and prevention.","volume":"10","author":"Gan","year":"2017","journal-title":"J Pain Res"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1604600","DOI":"10.3389\/fmed.2025.1604600","article-title":"Hydromorphone ameliorates postoperative pain and depressive disorder in women receiving cesarean section under spinal anesthesia.","volume":"12","author":"Ouyang","year":"2025","journal-title":"Front Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1016\/j.bja.2022.08.038","article-title":"Efficacy of preemptive analgesia treatments for the management of postoperative pain: a network meta-analysis.","volume":"129","author":"Xuan","year":"2022","journal-title":"Br J Anaesth"},{"key":"B6","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1097\/01.JAA.0000684128.83801.e6","article-title":"Intrathecal hydromorphone as an analgesia option for gynecology patients.","volume":"33","author":"Gajarawala","year":"2020","journal-title":"JAAPA"},{"key":"B7","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1093\/bja\/aer232","article-title":"Comparative clinical effects of hydromorphone and morphine: a meta-analysis.","volume":"107","author":"Felden","year":"2011","journal-title":"Br J Anaesth"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2187","DOI":"10.2147\/JPR.S257337","article-title":"Effects of additional intraoperative administration of sufentanil on postoperative pain, stress and inflammatory responses in patients undergoing laparoscopic myomectomy: a double-blind, randomized, placebo-controlled trial.","volume":"13","author":"Liu","year":"2020","journal-title":"J Pain Res"},{"key":"B9","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1002\/j.1532-2149.2012.00211.x","article-title":"The impact of intra-operative sufentanil dosing on post-operative pain, hyperalgesia and morphine consumption after cardiac surgery.","volume":"17","author":"Fechner","year":"2013","journal-title":"Eur J Pain"},{"key":"B10","doi-asserted-by":"publisher","first-page":".e1","DOI":"10.1016\/j.ajog.2019.04.012","article-title":"Guidelines for postoperative care in cesarean delivery: enhanced recovery after surgery (ERAS) society recommendations (part 3).","volume":"221","author":"Macones","year":"2019","journal-title":"Am J Obstet Gynecol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e28615","DOI":"10.1097\/MD.0000000000028615","article-title":"Hydromorphone vs sufentanil in patient-controlled analgesia for postoperative pain management: a meta-analysis.","volume":"101","author":"Nie","year":"2022","journal-title":"Medicine"},{"key":"B12","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s12871-018-0500-1","article-title":"Prospective investigation of intravenous patient-controlled analgesia with hydromorphone or sufentanil: impact on mood, opioid adverse effects, and recovery.","volume":"18","author":"Yang","year":"2018","journal-title":"BMC Anesthesiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"104811","DOI":"10.1016\/j.ijoa.2025.104811","article-title":"Professional society recommended interventions for enhanced recovery after cesarean delivery in the United States: a multidisciplinary Delphi study.","volume":"65","author":"Sultan","year":"2026","journal-title":"Int J Obstet Anesth"},{"key":"B14","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1016\/j.bja.2019.06.009","article-title":"Side effect profiles of different opioids in the perioperative setting: are they different and can we reduce them?","volume":"123","author":"Shim","year":"2019","journal-title":"Br J Anaesth"},{"key":"B15","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1016\/s0304-3959(97)00059-6","article-title":"Comparative efficacy of patient-controlled administration of morphine, hydromorphone, or sufentanil for the treatment of oral mucositis pain following bone marrow transplantation.","volume":"72","author":"Coda","year":"1997","journal-title":"Pain"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v045.i03","article-title":"mice: Multivariate imputation by chained equations in R.","volume":"45","author":"van Buuren","year":"2011","journal-title":"J Stat Softw."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v042.i08","article-title":"MatchIt: nonparametric preprocessing for parametric causal inference.","volume":"42","author":"Ho","year":"2011","journal-title":"J Stat Softw."},{"key":"B19","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1002\/pst.433","article-title":"Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies.","volume":"10","author":"Austin","year":"2011","journal-title":"Pharm Stat"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e43041","DOI":"10.1097\/MD.0000000000043041","article-title":"Postoperative analgesic effect of dezocine combined with sufentanil: a propensity score matching study.","volume":"104","author":"Li","year":"2025","journal-title":"Medicine"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1834000\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:38:08Z","timestamp":1783661888000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1834000\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,10]]},"references-count":20,"alternative-id":["10.3389\/fmed.2026.1834000"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1834000","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,10]]},"article-number":"1834000"}}