Impact of Intravenous Methadone Administered Intraoperatively on Postoperative Opioid Utilization

Area of Science:

• Anesthesiology
• Pharmacology
• Pain Management

Background:

• Intravenous methadone administration during surgery has been suggested to decrease postoperative opioid requirements.
• Optimizing postoperative pain management and opioid utilization remains a critical area in surgical care.

Purpose of the Study:

• To investigate the impact of intraoperative intravenous methadone on postoperative opioid consumption.
• To assess secondary outcomes including pain scores and length of hospital stay.

Main Methods:

• A prospective, single-center observational study compared patients receiving intraoperative intravenous methadone with a matched control group (1:3 ratio).
• Exclusion criteria included patients under 18 or on methadone maintenance.
• Primary outcome was 24-hour postoperative morphine milligram equivalents (MME); secondary outcomes included MME at 48 and 72 hours, discharge MME, pain scores, and hospital stay.

Main Results:

• Postoperative MME at 24, 48, and 72 hours were significantly higher in the methadone group compared to controls (P < 0.0026).
• No significant difference in daily pain scores or discharge prescription MME was observed between groups.
• Opioid-naïve patients receiving methadone showed a significant reduction in 48-hour MME (P = 0.0240) and 24-hour pain scores (P = 0.0366).

Conclusions:

• Intraoperative intravenous methadone did not reduce overall postoperative opioid use or discharge prescriptions.
• A potential benefit was observed in opioid-naïve patients, with reduced MME and pain scores.
• Further research is warranted to clarify the role of methadone in specific patient populations for postoperative pain management.