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Intra-operative methadone effect on quality of recovery compared with morphine following laparoscopic gastroplasty: a
J P J Pontes1,1, F R Braz1, N S P Módolo2
1Department of Anaesthesiology, Santa Genoveva Hospital Complex, Uberlândia, Minas Gerais, Brazil.
Abstract:
The effect of intra-operative intravenous methadone on quality of postoperative recovery was compared with morphine after laparoscopic gastroplasty. We included 137 adult patients with a body mass index > 35 kg.m-2 who underwent bariatric surgery. Patients were allocated at random to receive either intra-operative methadone (n = 69) or morphine (n = 68). All patients received the same postoperative care and analgesia. The primary outcome of postoperative quality of recovery was assessed using the Quality of Recovery-40 questionnaire total score 24 h after surgery. Secondary outcomes were assessed in the post-anaesthesia care unit the night of the day of surgery (T1), in the morning after surgery (T2); and at night on the day following surgery (T3). The median (IQR [range]) total Quality of Recovery-40 questionnaire score of 194 (190-197 [165-200]) was higher (p < 0.0001) in the methadone group compared with the score of 181 (174-185.5 [121-200]) in the morphine group. In the post-anaesthesia care unit, the pain burden; incidence of nausea and vomiting; rescue morphine dose; and time to discharge, were significantly lower in the methadone group. On the ward, the methadone group had a lower: incidence of rescue morphine requests at T1 (5.8 vs. 54.4%, p < 0.0001) and T2 (0 vs. 20.1%, p < 0.0001); and incidence of nausea (21.7 vs. 41.2%, p = 0.014), compared with the morphine group. We conclude that intra-operative intravenous methadone improved quality of recovery in patients who underwent laparoscopic gastroplasty, compared with intra-operative morphine. Methadone also reduced postoperative pain, postoperative opioid consumption and the incidence of opioid-related adverse events.
Insights
Intra-operative intravenous methadone significantly improved postoperative recovery quality in laparoscopic gastroplasty patients compared to morphine. Methadone also reduced pain, opioid use, and adverse events, enhancing patient outcomes.
Area of Science:
- Anesthesiology
- Surgical Recovery
- Pharmacology
Background:
- Postoperative recovery quality is crucial after bariatric surgery.
- Opioid analgesics like morphine are commonly used but can cause adverse events.
- Optimizing intra-operative medication may improve patient outcomes.
Purpose of the Study:
- To compare the effect of intra-operative intravenous methadone versus morphine on the quality of postoperative recovery after laparoscopic gastroplasty.
- To evaluate secondary outcomes including pain, nausea, vomiting, and opioid consumption.
Main Methods:
- A randomized controlled trial involving 137 adult patients undergoing bariatric surgery with BMI > 35 kg/m².
- Patients received either intra-operative methadone (n=69) or morphine (n=68).
- Quality of recovery was assessed using the Quality of Recovery-40 questionnaire 24 hours post-surgery; secondary outcomes were measured at multiple time points.
Main Results:
- The methadone group showed a significantly higher Quality of Recovery-40 score (194 vs. 181, p < 0.0001).
- Methadone group experienced lower pain burden, reduced nausea/vomiting, and decreased rescue morphine use in the post-anesthesia care unit and on the ward.
- Incidence of rescue morphine requests and nausea was significantly lower in the methadone group postoperatively.
Conclusions:
- Intra-operative intravenous methadone enhances postoperative recovery quality in patients undergoing laparoscopic gastroplasty compared to morphine.
- Methadone effectively reduces postoperative pain, opioid consumption, and opioid-related adverse events.
- Methadone represents a beneficial alternative for intra-operative analgesia in bariatric surgery patients.
