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The effect of intraoperative methadone during pediatric cardiac surgery on postoperative opioid requirements
Annika M Barnett1, Kelly A Machovec1, Warwick A Ames1
1Department of Anesthesia, Duke University Medical Center, Durham, NC, USA.
Insights
Intravenous methadone use in pediatric cardiac surgery patients reduced intraoperative opioid needs. This approach may decrease overall opioid and sedative use, potentially shortening hospital stays for these young patients.
Area of Science:
- Pediatric Cardiac Surgery
- Anesthesiology
- Pain Management
Background:
- Pediatric cardiac surgery patients often require prolonged opioid infusions and sedation.
- This can lead to extended weaning periods and longer hospitalizations.
- Effective pain management is crucial for recovery.
Purpose of the Study:
- To evaluate the efficacy of intravenous methadone as the sole intraoperative opioid in pediatric cardiac surgery.
- To determine if methadone reduces overall perioperative opioid and sedative requirements.
- To assess the impact on pain control and hospital stay duration.
Main Methods:
- A practice change was implemented, comparing patients before and after introducing intraoperative methadone.
- Patients were divided into neonatal (<30 days) and non-neonatal (30 days to 18 years) groups.
- Primary outcome: intraoperative and postoperative opioid requirements (morphine equivalents). Secondary outcomes: extubation, pain/sedation scores, sedation use.
Main Results:
- Neonatal group: post-methadone patients needed significantly less intraoperative opioids; no difference in postoperative use.
- Non-neonatal group: post-methadone patients required less intraoperative and less postoperative opioids in the first 24 hours.
- Demographics were similar between groups.
Conclusions:
- Intraoperative methadone is a viable alternative to fentanyl for pediatric cardiac surgery.
- Methadone may decrease total intraoperative and postoperative opioid and sedative doses.
- Further research is needed to assess long-term opioid needs and ICU team utilization.
Background:
Pain control in pediatric patients undergoing cardiac surgery presents a unique challenge. Postoperatively, many of these patients require long-term opioid infusions and sedation leading to need for prolonged weaning from opioids and longer hospital stays. We hypothesized that intravenous methadone as the sole opioid in children having cardiac surgery with cardiopulmonary bypass would improve perioperative pain control and decrease overall perioperative use of opioid analgesics and sedatives.
Methods:
We instituted a practice change involving pediatric patients aged <18 years who underwent cardiac surgery with cardiopulmonary bypass over a 14-month period, comparing the patient population who had surgery prior to the institution of intraoperative methadone usage to patients who had surgery in the months following. We then separated patients into two groups: neonatal (aged < 30 days) and non-neonatal (aged > 30 days to 18 years). Our primary outcome was intraoperative and postoperative opioid requirements measured in morphine equivalents intraoperatively, during the first 24 hours postoperatively, and up to postoperative day 7. Secondary outcomes included extubation rates in the OR, pain and sedation scores, sedation requirements, and time to start of oxycodone.
Results:
Patients in both groups had similar demographics. In neonatal patients, the postintervention group required significantly lower doses of intraoperative opioids. There was no statistically significant difference in postoperative opioid use. In non-neonatal patients, the postintervention group required significantly less intraoperative opioids. Postoperatively, those in the postintervention group required significantly less opioids in the first 24 hours.
Conclusion:
The use of intraoperative methadone appears to be a reasonable alternative to the use of fentanyl with potential other benefits both intra- and postoperatively of decreased total dose of opioids and other sedatives. Future studies will assess for any improvement in total postoperative opioid requirements during the total hospital stay, and potential use of methadone by the ICU team.
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