Intraoperative Methadone for Post-craniotomy Pain Control: A Matched Cohort Exploratory Framework Study

Area of Science:

• Neurosurgery
• Anesthesiology
• Pharmacology

Background:

• Postoperative pain after craniotomy often requires multimodal analgesia with frequent dosing, increasing opioid burden.
• Methadone, acting as a μ-opioid receptor agonist and NMDA receptor antagonist, presents a potential for extended analgesia from a single intraoperative dose.

Purpose of the Study:

• To assess the feasibility and preliminary efficacy of intraoperative methadone for managing postoperative pain in craniotomy patients.
• To compare postoperative pain scores and opioid consumption between patients receiving methadone and those on conventional opioid regimens.

Main Methods:

• A single-center, retrospective, matched cohort study involving adult patients undergoing craniotomy for tumor resection.
• Analysis of primary outcomes including postoperative pain scores and opioid consumption at 24, 48, and 72 hours post-surgery.
• Comparison of eight patients who received intraoperative methadone with 24 control patients.

Main Results:

• No significant differences in pain scores or opioid use were observed at 24 hours between the methadone and control groups.
• The methadone group showed numerically lower pain scores and opioid consumption at 48 and 72 hours, though the study was underpowered to confirm statistical significance.
• No methadone-associated safety concerns were identified during the study period.

Conclusions:

• Intraoperative methadone administration was found to be feasible in the context of craniotomy surgery.
• Methadone appeared comparable to conventional opioid regimens, with emerging trends suggesting potential benefits in reducing later postoperative pain and opioid requirements.
• These exploratory findings warrant further investigation through prospective trials to definitively establish methadone's role in neurosurgical pain management.