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

Zoey A Croft1, Sean Inzerillo2, Shoaib Syed1

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Summary

Intraoperative methadone may offer feasible pain management for craniotomy patients, showing trends toward reduced pain and opioid use at later timepoints without safety concerns. Further trials are needed to confirm its role in neurosurgical analgesia.

Keywords:
craniotomymethadoneopioid agonistpain managementpostoperative pain

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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.