Comprehensive Perioperative Management Considerations in Patients Taking Methadone

Cornett, Elyse M.; Kline, Ryan J.; Robichaux, Spencer; Green, Jeremy B.; Anyama, Boris C; Gennuso, Sonja A.; Okereke, Eva C; Kaye, Alan D.

doi:10.1007/s11916-019-0783-z

Cited by 11 publications

(7 citation statements)

References 60 publications

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“…Fractionating the methadone dose (TID or QID) may improve analgesia; however, the outpatient methadone daily dose should again ideally not be increased. 82,83…”

Section: Perioperative Considerations For Patients Prescribed Moudmentioning

confidence: 99%

Caring for Our Patients With Opioid Use Disorder in the Perioperative Period: A Guide for the Anesthesiologist

Barreveld,

Mendelson,

Deiling

et al. 2023

Anesthesia &Amp; Analgesia

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Opioid use disorder (OUD) is a rising public health crisis, impacting millions of individuals and families worldwide. Anesthesiologists can play a key role in improving morbidity and mortality around the time of surgery by informing perioperative teams and guiding evidence-based care and access to life-saving treatment for patients with active OUD or in recovery. This article serves as an educational resource for the anesthesiologist caring for patients with OUD and is the second in a series of articles published in Anesthesia & Analgesia on the anesthetic and analgesic management of patients with substance use disorders. The article is divided into 4 sections: (1) background to OUD, treatment principles, and the anesthesiologist; (2) perioperative considerations for patients prescribed medications for OUD (MOUD); (3) perioperative considerations for patients with active, untreated OUD; and (4) nonopioid and nonpharmacologic principles of multimodal perioperative pain management for patients with untreated, active OUD, or in recovery. The article concludes with a stepwise approach for the anesthesiologist to support OUD treatment and recovery. The anesthesiologist is an important leader of the perioperative team to promote these suggested best practices and help save lives.

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“…Fractionating the methadone dose (TID or QID) may improve analgesia; however, the outpatient methadone daily dose should again ideally not be increased. 82,83…”

Section: Perioperative Considerations For Patients Prescribed Moudmentioning

confidence: 99%

Caring for Our Patients With Opioid Use Disorder in the Perioperative Period: A Guide for the Anesthesiologist

Barreveld,

Mendelson,

Deiling

et al. 2023

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

show abstract

“…Researchers have proposed algorithms for managing patients on methadone presenting for elective surgery. If the patient can tolerate oral medication, then it is advised to continue oral methadone on the morning of surgery and throughout the perioperative period ( 16 , 21 , 27 ). If the patient is unable to do so, then methadone can be dosed parenterally at a dose half to two-thirds of the maintenance dose divided into two to four equal doses a day ( 21 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

“…In situations when methadone is not available, the conversion of methadone to any opioid can be performed; however, the conversion calculations may not be bidirectional due to the long half-life of methadone ( 21 ). A multimodal approach ( 16 , 27 ) including the perioperative infusion of ketamine ( 28 , 29 , 30 ), clonidine ( 31 ), and the use of regional anesthesia ( 32 ) should be considered. In a retrospective cohort study performed by Macintyre et al ( 26 ), methadone opioid substitution therapy was continued and it showed the efficacy and safety of PCA opioids for the management of postoperative pain ( 26 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

Perioperative Management of Patients on Buprenorphine and Methadone: A Narrative Review

Sritapan¹,

Clifford²,

Bautista³

2020

Balkan Med J

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The opioid epidemic has emerged as a major health and social problem over the last few decades. An increasing number of patients with opioid use disorder are presenting for perioperative management. These patients are either on buprenorphine or methadone for the maintenance and treatment of opioid addiction or chronic pain. In the settings of acute pain, the optimal management of patients with opioid use disorder is challenging, and recovery can be jeopardized secondary to the unique pharmacology of these agents. The purpose of this narrative review is to summarize the existing studies on the perioperative management of patients who are using buprenorphine and methadone and provide guidance for the management of patients with opioid use disorder during the perioperative period.

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“…Another challenge involves more vigilant postoperative monitoring. Escalating doses increase the risk of cardiac and neurologic depression and opioid-induced hypoventilation (Cornett et al 2019). These adverse events are nine times more likely to occur when patients take more than 100mg oral morphine equivalents (OMEs) daily compared with less than 20mg OMEs daily (Cornett et al 2019).…”

Section: Introductionmentioning

confidence: 99%

“…Escalating doses increase the risk of cardiac and neurologic depression and opioid-induced hypoventilation (Cornett et al 2019). These adverse events are nine times more likely to occur when patients take more than 100mg oral morphine equivalents (OMEs) daily compared with less than 20mg OMEs daily (Cornett et al 2019). Owing to the various opioid formulations, doses, and delivery methods of opioids, the term OMEs is used to describe opioid use and also to compare or convert one opioid to another.…”

Section: Introductionmentioning

confidence: 99%

Improving satisfaction with postoperative pain management for patients with persistent pain: a preoperative pain medicine consultation intervention

Lovett

Miller

Pitruzzello

et al. 2019

Journal of Perioperative Practice

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Purpose Preoperative pain medicine consultations with opioid-tolerant patients allow for an accurate medication history, patient involvement in the postoperative plan, and realistic goal setting. The purpose of this quality improvement project was to increase attendance at preoperative pain consultations, thereby increasing patient satisfaction. Methods Retrospective chart reviews identified patients who had a preoperative pain consultation ordered from May through July 2016. Patient interviews determined reasons for not attending appointments, involvement in goal setting, engagement in pain management planning, and satisfaction with postoperative pain management. Results Retrospective chart reviews and interviews were conducted after the intervention (May–July 2017). Scheduling changes increased attendance at preoperative pain consultations by 14 percentage points (50% vs 64%). Those who attended consultations were more involved in goal setting and decisions and were more satisfied. Conclusions Preoperative pain consultations with opioid-tolerant patients can increase satisfaction through realistic goal setting and involvement in the pain management plan.

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Comprehensive Perioperative Management Considerations in Patients Taking Methadone

Cited by 11 publications

References 60 publications

Caring for Our Patients With Opioid Use Disorder in the Perioperative Period: A Guide for the Anesthesiologist

Caring for Our Patients With Opioid Use Disorder in the Perioperative Period: A Guide for the Anesthesiologist

Perioperative Management of Patients on Buprenorphine and Methadone: A Narrative Review

Improving satisfaction with postoperative pain management for patients with persistent pain: a preoperative pain medicine consultation intervention

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