Intraoperative Methadone in Same-Day Ambulatory Surgery: A Randomized, Double-Blinded, Dose-Finding Pilot Study

Area of Science:

• Anesthesiology and Pain Management
• Pharmacology
• Surgical Outcomes

Background:

• Ambulatory surgery impacts millions of US patients annually.
• Postoperative opioid overprescribing is a significant issue, often coexisting with inadequate pain relief.
• Intraoperative methadone has shown promise in inpatient settings for improved analgesia and reduced opioid use.

Purpose of the Study:

• To evaluate the efficacy of intraoperative methadone compared to short-duration opioids in reducing opioid consumption and pain in same-day ambulatory surgery.
• To determine an effective intraoperative induction dose of methadone for ambulatory surgical procedures.

Main Methods:

• A double-blind, randomized (2:1) dose-escalation study involving 60 patients.
• Patients received either single-dose intraoperative intravenous methadone (0.1 or 0.15 mg/kg ideal body weight) or conventional short-duration opioids.
• Outcomes included in-hospital and 30-day opioid consumption, pain intensity, and side effects.

Main Results:

• The 0.15 mg/kg methadone dose significantly reduced postanesthesia care unit opioid consumption compared to controls (P < .001).
• Total in-hospital non-methadone opioid use was significantly lower in both methadone groups versus controls (P < .001).
• Patients receiving 0.15 mg/kg methadone reported less pain at rest and used fewer opioid pills for 30 days post-discharge.

Conclusions:

• A single intraoperative dose of methadone at 0.15 mg/kg ideal body weight is effective in reducing opioid requirements and postoperative pain in same-day ambulatory surgery.
• This approach offers comparable side effect profiles to conventional opioid regimens.
• The study identified an effective dose for intraoperative methadone in the ambulatory setting.