Intraoperative Methadone for the Prevention of Postoperative Pain
- 1 May 2015
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Anesthesiology
- Vol. 122 (5), 1112-1122
- https://doi.org/10.1097/aln.0000000000000633
Abstract
Background: The intensity of pain after cardiac surgery is often underestimated, and inadequate pain control may be associated with poorer quality of recovery. The aim of this investigation was to examine the effect of intraoperative methadone on postoperative analgesic requirements, pain scores, patient satisfaction, and clinical recovery. Methods: Patients undergoing cardiac surgery with cardiopulmonary bypass (n = 156) were randomized to receive methadone (0.3 mg/kg) or fentanyl (12 μg/kg) intraoperatively. Postoperative analgesic requirements were recorded. Patients were assessed for pain at rest and with coughing 15 min and 2, 4, 8, 12, 24, 48, and 72 h after tracheal extubation. Patients were also evaluated for level of sedation, nausea, vomiting, itching, hypoventilation, and hypoxia at these times. Results: Postoperative morphine requirements during the first 24 h were reduced from a median of 10 mg in the fentanyl group to 6 mg in the methadone group (median difference [99% CI], −4 [−8 to −2] mg; P < 0.001). Reductions in pain scores with coughing were observed during the first 24 h after extubation; the level of pain with coughing at 12 h was reduced from a median of 6 in the fentanyl group to 4 in the methadone group (−2 [−3 to −1]; P < 0.001). Improvements in patient-perceived quality of pain management were described in the methadone group. The incidence of opioid-related adverse events was not increased in patients administered methadone. Conclusions: Intraoperative methadone administration resulted in reduced postoperative morphine requirements, improved pain scores, and enhanced patient-perceived quality of pain management.Keywords
This publication has 39 references indexed in Scilit:
- The Use of Very-Low-Dose Methadone for Palliative Pain Control and the Prevention of Opioid HyperalgesiaJournal of Palliative Medicine, 2013
- Perioperative Pharmacokinetics of Methadone in AdolescentsAnesthesiology, 2011
- Intraoperative MethadoneAnesthesia & Analgesia, 2011
- Acute Methadone Treatment Reduces Myocardial Infarct Size via the δ-Opioid Receptor in Rats During ReperfusionAnesthesia & Analgesia, 2009
- Frequency, Indications, Outcomes, and Predictive Factors of Opioid Switching in an Acute Palliative Care UnitJournal of Pain and Symptom Management, 2009
- Thoracic Epidural versus Intravenous Patient-controlled Analgesia after Cardiac SurgeryAnesthesiology, 2006
- Coronary artery disease and opioid useThe American Journal of Cardiology, 2004
- The d- and l- isomers of methadone bind to the non-competitive site on the N-methyl-d-aspartate (NMDA) receptor in rat forebrain and spinal cordNeuroscience Letters, 1997
- Postoperative pain control with methadone following lower abdominal surgeryJournal of Clinical Anesthesia, 1991
- Postoperative Pain Control with Methadone: Influence of Supplementary Methadone Doses and Blood Concentration—Response RelationshipsAnesthesiology, 1984