Intraoperative Methadone: A New Enhanced Recovery After Surgery Pathway for Deep Inferior Epigastric Perforator Flap...

Area of Science:

• Plastic Surgery
• Anesthesiology
• Pain Management

Background:

• Inadequate postoperative pain management increases morbidity, including surgical complications and chronic pain.
• Single-dose methadone may offer superior analgesia compared to multiple short-acting opioids.
• Enhanced Recovery After Surgery (ERAS) protocols aim to optimize patient recovery pathways.

Purpose of the Study:

• To evaluate the effectiveness of an ERAS protocol for deep inferior epigastric perforator flap breast reconstruction.
• To assess the impact of a single, weight-based intraoperative methadone dose within the ERAS protocol.
• To compare outcomes between ERAS and historical control cohorts.

Main Methods:

• Retrospective review of a historical control cohort (n=29) from October 2020 to March 2021.
• Prospective enrollment in an ERAS protocol cohort (n=54) from April 2021 to January 2022.
• Comparison of primary outcomes: length of stay, postoperative opioid consumption, pain scores, heart rates, and tachycardia incidence.

Main Results:

• No significant difference in length of stay between ERAS and non-ERAS cohorts (P=0.68).
• ERAS cohort showed significantly reduced postoperative opioid consumption at 12h (P<0.001), 24h (P<0.001), and throughout admission (P=0.002).
• ERAS cohort experienced significantly lower pain scores (P=0.021 at 24h, P=0.0051 overall), heart rates (P<0.001 overall), and incidence of tachycardia (P=0.029).

Conclusions:

• Implementing an ERAS protocol with a single intraoperative methadone dose significantly decreased postoperative opioid use, pain, heart rate, and tachycardia.
• Methadone shows potential for reducing pain and opioid consumption in inpatient and ambulatory plastic surgery.
• This pilot study suggests methadone can enhance patient comfort and satisfaction following plastic surgery procedures.