Related Experiment Video
Updated: Jan 24, 2026
Acupoint Needle-Embedding Combined with Ironing Therapy for Postoperative Pain After Anal Surgery
Published on: June 23, 2023
A preoperative single dose of methadone for moderate-to-severely painful surgery reduces postoperative morphine
Kathleen Bastian1, Philipp K Buehler2, Dovile Slizyte1
1Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.
Background:
Data from patient questionnaires reveal that the intensity of postoperative pain is widely underestimated. Insufficient pain control may contribute to impaired short- and long-term outcome. Preoperative administration of methadone might potentially improve postoperative pain control due to its long pharmacological half-life.
Methods:
The aim of this study was to evaluate the effect of a single dose of methadone administered at anesthesia induction on postoperative analgesic requirements in ASA I-III patients after moderate-to-severely painful surgery scheduled for ≥90 minutes. Patients were randomized to receive either a single dose of methadone (0.2 mg/kg) or fentanyl (standard, 0.003 mg/kg) intravenously (IV) at anesthesia induction. For postoperative pain control, all study patients were accommodated with morphine on the basis of patient-controlled analgesia (PCA).
Results:
Per-protocol analysis revealed that the median cumulative morphine consumption was significantly lower in patients receiving a single dose of methadone, in the Postanesthesia Care Unit (0 mg vs. 7 mg of morphine, P<0.01) and during the first 72 hours after surgery (19 mg vs. 35 mg of morphine, P<0.05 for all days). Fentanyl consumption during surgery (0.25 mg [0.1-0.425 mg] in the study group vs. 0.3 mg [0.15-0.45 mg] in the control group, P=0.4499) was comparable among groups. Median pain scores at rest and in motion, and patient satisfaction were also similar in both groups (95.7% vs. 89.3% of patients were satisfied in the study and control group, respectively) during follow-up on postoperative days 1-3.
Conclusions:
A single dose of methadone administered at anesthesia induction prior to moderate-to-severely painful surgery is a possible strategy to reduce postoperative morphine consumption.
Insights
Preoperative methadone significantly reduced postoperative morphine use in patients undergoing painful surgery. This strategy may improve pain management and patient outcomes after anesthesia.
Area of Science:
- Anesthesiology
- Pharmacology
- Pain Management
Background:
- Postoperative pain is often underestimated, leading to inadequate pain control.
- Poor pain management can negatively impact both short-term and long-term patient outcomes.
- Methadone's long half-life suggests potential for improved postoperative pain control when given preoperatively.
Purpose of the Study:
- To assess the impact of a single methadone dose at anesthesia induction on postoperative analgesic needs.
- To compare methadone with fentanyl as a pre-anesthetic agent for pain management.
- To evaluate methadone's efficacy in patients undergoing moderately to severely painful surgery.
Main Methods:
- Randomized study of patients (ASA I-III) undergoing surgery lasting ≥90 minutes.
- Intervention group received intravenous methadone (0.2 mg/kg) at anesthesia induction.
- Control group received intravenous fentanyl (0.003 mg/kg) at anesthesia induction; both groups used patient-controlled analgesia (PCA) morphine postoperatively.
Main Results:
- Methadone group showed significantly lower cumulative morphine consumption in the PACU (0 mg vs. 7 mg) and over 72 hours (19 mg vs. 35 mg).
- Intraoperative fentanyl consumption was similar between groups.
- Pain scores and patient satisfaction were comparable between the methadone and fentanyl groups postoperatively.
Conclusions:
- A single preoperative dose of methadone can effectively reduce postoperative morphine requirements.
- Methadone administration at anesthesia induction is a viable strategy for managing pain after moderate-to-severe surgery.
- This approach may enhance postoperative pain control and potentially improve patient recovery.
Related Concept Videos
01:20Opioid Analgesics: Morphine and Other Natural Cogeners
01:11Bioavailability Study Design: Single Versus Multiple Dose Studies
01:21Dose Size and Dosing Frequency: Determination Methods
01:25Determination of Multiple Dosing Parameters: Loading and Maintenance Doses
01:20Pain
01:24Rational Dosage Regimen: Maintenance Dose and Loading Dose
In most cases, drugs are administered repetitively or infused continuously to maintain a steady-state concentration in the body. At a steady...