Perioperative Methadone in Orthopedic Surgery: A Scoping Review.

Area of Science:

• Anesthesiology and Pain Management
• Orthopedic Surgery
• Pharmacology

Background:

• Postoperative pain management in orthopedic surgery often relies on opioids.
• The role of intraoperative methadone as an adjunct analgesic is under investigation.
• Evaluating methadone's efficacy and safety for orthopedic pain is crucial.

Purpose of the Study:

• To conduct a scoping review of literature on intraoperative methadone in orthopedic surgery.
• To synthesize findings on pain scores, opioid consumption, and adverse effects.
• To assess the efficacy and safety of perioperative methadone for postoperative pain.

Main Methods:

• Scoping review of Medline, PubMed, and Scopus databases (2000-2025).
• Inclusion criteria: intraoperative methadone, orthopedic surgery, reported outcomes.
• Qualitative synthesis of 13 selected studies.

Main Results:

• Intraoperative methadone (0.2 mg/kg) significantly reduced postoperative opioid consumption (up to 50%) and pain scores (up to 72h) in adult spine surgery.
• Multimodal regimens with methadone reduced opioid use by up to 76% in pediatric spine surgery.
• Morphine was superior to methadone in arthroscopic knee surgery; safety profile was acceptable.

Conclusions:

• Perioperative methadone is an effective analgesic adjunct, reducing pain and opioid needs in major spine surgery within multimodal strategies.
• Methadone's efficacy is context-dependent, varying across orthopedic procedures.
• Further research is required to optimize dosing and define its role in diverse orthopedic surgeries.