Intraoperative Low-Dose Methadone for Pediatric Posterior Spinal Fusion: A Single-Center Retrospective Cohort Study

Area of Science:

• Anesthesiology
• Pediatric Orthopedics
• Pain Management

Background:

• Adolescent idiopathic scoliosis surgery (posterior spinal fusion) causes significant pain and opioid use.
• Methadone, a dual opioid and NMDA antagonist, offers long-acting analgesia.
• Its potential to reduce perioperative opioid requirements in pediatric spinal fusion is under investigation.

Purpose of the Study:

• To evaluate if perioperative low-dose methadone (0.1 mg/kg) improves postoperative pain and opioid outcomes in pediatric posterior spinal fusion.
• To assess methadone's impact on total opioid consumption, pain scores, and hospital length of stay.

Main Methods:

• Single-center retrospective cohort study of pediatric patients (<23 years) undergoing posterior spinal fusion.
• Patients were categorized by perioperative methadone exposure versus no methadone.
• Inverse probability weighting (IPW) adjusted for confounding factors; primary outcome was total postoperative opioid consumption (MME/kg) on POD 0-3.

Main Results:

• 339 patients analyzed; methadone group had longer anesthesia and surgery times.
• IPW-adjusted analysis showed significantly higher early opioid use (POD 0) in the methadone group.
• No significant differences in average pain scores or hospital length of stay between groups.

Conclusions:

• Perioperative low-dose methadone did not demonstrate an opioid-sparing effect in pediatric posterior spinal fusion.
• It was associated with higher early postoperative opioid use but similar pain control and length of stay.
• Further prospective trials are needed to define methadone's role and safety in this setting.