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Asociación entre la administración intraoperatoria de metadona y la prolongación del intervalo QTc: un análisis de

Jasper Koolwijk¹, Sonja Babac^2,3, Marcel Van 't Veer⁴

¹Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands jasper.koolwijk@catharinaziekenhuis.nl.

Regional anesthesia and pain medicine

|February 4, 2026

Resumen

El uso perioperatorio de metadona no aumentó el riesgo de prolongación intraoperatoria del intervalo QTc. Este estudio no encontró diferencias significativas en la prolongación del QTc entre los pacientes que recibieron metadona y los que no, lo que sugiere su uso seguro para el manejo del dolor.

Área de la Ciencia:

Anestesiología y Medicina Perioperatoria
Cardiología
Farmacología

Sus antecedentes:

El uso perioperatorio de metadona está aumentando para el manejo del dolor.
Se sabe que la metadona prolonga el intervalo QTc, lo que aumenta el riesgo de Torsades de Pointes.
No se comprende bien el impacto de las dosis de carga intraoperatoria de metadona en la prolongación del QTc.

Objetivo del estudio:

Investigar la asociación entre las dosis de carga intraoperatoria de metadona y la prolongación del intervalo QTc.
Evaluar la incidencia de la prolongación del QTc que excede umbrales específicos en pacientes que reciben metadona durante la cirugía.

Principales métodos:

Estudio de cohorte observacional retrospectivo de pacientes adultos sometidos a cirugía mayor no cardiopulmonar.
Comparación de pacientes que recibieron dosis de carga intraoperatoria de metadona frente a los que no.
Análisis de electrocardiogramas (ECG) utilizando un algoritmo basado en wavelet para medir los intervalos QTc en la línea de base y de forma intraoperatoria.
Emparejamiento por puntuación de propensión para controlar las variables de confusión.

Principales resultados:

Después del emparejamiento por puntuación de propensión, no se observaron diferencias significativas en la prolongación del intervalo QTc entre los grupos de metadona y no metadona.
La incidencia de prolongación del intervalo QTc >500 ms, el aumento de ≥30 ms y el aumento de ≥60 ms desde la línea de base fueron similares entre los grupos.
El grupo sin metadona pasó un porcentaje significativamente mayor del tiempo intraoperatorio por encima del umbral de >500 ms.

Conclusiones:

Las dosis de carga intraoperatoria de metadona no se asociaron con un aumento de la incidencia de prolongación intraoperatoria del intervalo QTc.
La metadona se puede implementar de forma segura para el manejo del dolor perioperatorio sin aumentar significativamente los riesgos de prolongación del QTc.
Investigaciones adicionales pueden explorar los efectos cardíacos a largo plazo y las estrategias de dosificación óptimas.

Palabras clave:

Dolor Agudo Analgésicos Opioide Efectos Secundarios y Reacciones Adversas Relacionadas con Fármacos Dolor Postoperatorio Farmacología

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