Objective To systematically review available paediatric literature on comparisons between morphine (Mo) and hydromorphone (Hm), to guide clinicians to rationally use these medications. Design Systematic review within four databases for all studies published from 1963 to July 2019. Setting All paediatric settings. Eligibility All studies comparing Mo to Hm in individuals younger than 21 years. Main outcome measures The primary outcome was to compare clinical efficacy and side effects of Mo and Hm. The secondary outcomes were the comparison of pharmacokinetic profiles and the description of predefined Mo to Hm conversion ratios used across the paediatric literature. Results Among 754 abstracts reviewed, 59 full-text articles met inclusion criteria and 24 studies were included in the analysis: 4 studies compared pharmacodynamics of Mo and Hm and 20 studies reported the use of a predefined Mo to Hm conversion ratio. Most studies had a poor methodological quality. Available evidence suggests that, when given intravenously, the equianalgesic ratio of Mo to Hm is 5:1. Intravenous administration with this ratio results in a similar rate of adverse effects, including pruritus and nausea. The epidural administration with a ratio of 10:1 results in more pruritus and urinary retention with Mo than Hm. Pharmacokinetic data were reported in only one study. A wide range of pre-established ratios for different routes of administration were reported, but few were based on evidence. Conclusion Current literature does not permit a rational choice between Mo and Hm. A ratio of 5:1 seems adequate for intravenous administration and leads to a similar rate of adverse effects. All data relevant to the study are included in the article or uploaded as supplementary information.

中文翻译：

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吗啡或氢吗啡酮：应该首选哪个？系统评价

目的系统回顾现有儿科文献中吗啡（Mo）与氢吗啡酮（Hm）的比较，指导临床医师合理使用这些药物。设计 在四个数据库内对 1963 年至 2019 年 7 月发表的所有研究进行系统评价。设置 所有儿科设置。资格 在 21 岁以下的个体中比较 Mo 和 Hm 的所有研究。主要结局指标 主要结局是比较 Mo 和 Hm 的临床疗效和副作用。次要结果是药代动力学特征的比较和儿科文献中使用的预定义 Mo 到 Hm 转化率的描述。结果 在审查的 754 篇摘要中，59 篇全文文章符合纳入标准，24 项研究被纳入分析：4 项研究比较了 Mo 和 Hm 的药效学，20 项研究报告了使用预定义的 Mo 到 Hm 的转化率。大多数研究的方法学质量较差。现有证据表明，当静脉给药时，Mo 与 Hm 的等效镇痛比为 5:1。以该比例静脉给药会导致类似的不良反应发生率，包括瘙痒和恶心。硬膜外给药的比例为 10:1 导致瘙痒和尿潴留的 Mo 比 Hm 多。仅在一项研究中报告了药代动力学数据。报告了针对不同给药途径的各种预先确定的比率，但很少有基于证据的。结论 目前的文献不允许在 Mo 和 Hm 之间进行理性选择。比率为 5：1 似乎足以用于静脉内给药并导致类似的不良反应发生率。与研究相关的所有数据都包含在文章中或作为补充信息上传。