Comparação da analgesia pós‐operatória com uso de metadona versus morfina em cirurgia cardíaca

Carvalho, Ana Carolina de; Sebold, Fábio Jean Goulart; Calegari, Patrícia Mello Garcia; Oliveira, Benhur Heleno de; Schuelter‐Trevisol, Fabiana

doi:10.1016/j.bjan.2017.09.005

Cited by 26 publications

(3 citation statements)

References 18 publications

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“…In addition to its strong µ-opioid receptor agonist activity, methadone is a potent N-methyl-D-aspartate (NMDA) receptor antagonist, which may attenuate the development of opioid tolerance and hyperalgesia. In cardiac surgical patients, methadone has been reported to be safe and significantly reduces intraoperative and postoperative opioid requirements [23][24][25][26][27][28].…”

Section: Choices Of Medications To Facilitate Ftcamentioning

confidence: 99%

Methadone in combination with magnesium, ketamine, lidocaine, and dexmedetomidine improves postoperative outcomes after coronary artery bypass grafting: an observational multicentre study

Weinberg,

Johnston,

Fletcher

et al. 2024

J Cardiothorac Surg

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Background An optimal pharmacological strategy for fast-track cardiac anesthesia (FTCA) is unclear. This study evaluated the effectiveness and safety of an FTCA program using methadone and non-opioid adjuvant infusions (magnesium, ketamine, lidocaine, and dexmedetomidine) in patients undergoing coronary artery bypass grafting. Methods This retrospective, multicenter observational study was conducted across private and public teaching sectors. We studied patients managed by a fast-track protocol or via usual care according to clinician preference. The primary outcome was the total mechanical ventilation time in hours adjusted for hospital, body mass index, category of surgical urgency, cardiopulmonary bypass time and EuroSCORE II. Secondary outcomes included successful extubation within four postoperative hours, postoperative pain scores, postoperative opioid requirements, and the development of postoperative complications. Results We included 87 patients in the fast-track group and 88 patients in the usual care group. Fast-track patients had a 35% reduction in total ventilation hours compared with usual care patients (p = 0.007). Thirty-five (40.2%) fast-track patients were extubated within four hours compared to 10 (11.4%) usual-care patients (odds ratio: 5.2 [95% CI: 2.39–11.08; p < 0.001]). Over 24 h, fast-track patients had less severe pain (p < 0.001) and required less intravenous morphine equivalent (22.00 mg [15.75:32.50] vs. 38.75 mg [20.50:81.75]; p < 0.001). There were no significant differences observed in postoperative complications or length of hospital stay between the groups. Conclusion Implementing an FTCA protocol using methadone, dexmedetomidine, magnesium, ketamine, lignocaine, and remifentanil together with protocolized weaning from a mechanical ventilation protocol is associated with significantly reduced time to tracheal extubation, improved postoperative analgesia, and reduced opioid use without any adverse safety events. A prospective randomized trial is warranted to further investigate the combined effects of these medications in reducing complications and length of stay in FTCA. Trials registration The study protocol was registered in the Australian New Zealand Clinical Trials Registry (https://www.anzctr.org.au/ACTRN12623000060640.aspx, retrospectively registered on 17/01/2023).

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Section: Choices Of Medications To Facilitate Ftcamentioning

confidence: 99%

Methadone in combination with magnesium, ketamine, lidocaine, and dexmedetomidine improves postoperative outcomes after coronary artery bypass grafting: an observational multicentre study

Weinberg,

Johnston,

Fletcher

et al. 2024

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…In cardiac surgery, studies of IV methadone are limited. In a study comparing morphine and methadone where 0.1 mg/kg IV methadone or morphine was given at the end of the case, methadone showed 22% higher efficacy, lower pain scores, and decreased opioid consumption; however, time-to-first analgesic request was earlier in the methadone group 60 . A recent randomized controlled trial examined IV methadone (0.3 mg/kg) and fentanyl (12 μg/kg) in cardiac surgery.…”

Section: Methadone In Cardiac Surgerymentioning

confidence: 99%

“…In a study comparing morphine and methadone where 0.1 mg/kg IV methadone or morphine was given at the end of the case, methadone showed 22% higher efficacy, lower pain scores, and decreased opioid consumption; however, time-to-first analgesic request was earlier in the methadone group. 60 A recent randomized controlled trial examined IV methadone (0.3 mg/kg) and fentanyl (12 μg/kg) in cardiac surgery. IV methadone led to decreased opioid consumption in the first 24 hours, reduced pain scores with coughing, increased perceived quality of pain management, and no increase in opioid-related adverse events.…”

Section: Methadone In Cardiac Surgerymentioning

confidence: 99%