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Impact of Intravenous Methadone Administered Intraoperatively on Postoperative Opioid Utilization

Adina Petrosan1, Stefanie Zassman1, Sara Cohn1

  • 1Yale New Haven Hospital, New Haven, CT, USA.

The Annals of Pharmacotherapy
|February 22, 2021
PubMed
Abstract

Insights

Intravenous methadone given during surgery did not reduce overall postoperative opioid use. However, it did decrease opioid consumption and pain scores in opioid-naïve patients.

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.
Keywords:
methadoneopioid analgesicsopioid epidemicpain postoperative

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