Implementation and Results of Intraoperative Methadone in Pediatric Cardiac Surgery: Early Experiences and Outcomes

Postoperative pain continues to be an intense area of research in pediatric cardiac surgery, and there is a scarcity of information regarding the use of methadone in this population. We performed a single center retrospective descriptive cohort analysis of all pediatric cardiac surgery patients who received intraoperative methadone between January 1, 2020 and December 21, 2024. In total 111 congenital cardiac surgeries were completed in patients aged 0-18 years during the study period, of which 45 (41%) received intraoperative methadone. In the cohort receiving methadone, there were 29 male patients (64%), with an average age of 10.3 (SD±5.3) year. The average dose of methadone was 0.16mg/kg (SD±0.05mg/kg). With respect to post-operative analgesia, average pain scores at 6, 12, and 24 hours of 1.8 (SD±2.3), 1.95 (SD±2.7), and 1.44 (SD±2.2), respectively. The median 24-hour opioid requirement was 0.59 Morphine Milligram Equivalents(MME)/kg (IQR 0.25-0.96). In total, 32 of our 45 patients (71%) were able to be extubated in the operating room with no reintubations or need for rescue non-invasive positive pressure ventilation (NIPPV). Our study demonstrates that even a modest dose of intraoperative methadone in pediatric cardiac surgery can be safe and effective for intra and postoperative analgesia. Additional randomized controlled trials are necessary to further evaluate its effectiveness.