Intraoperative Methadone Improves Postoperative Pain Control in Patients Undergoing Complex Spine Surgery

Gottschalk, Antje; Durieux, Marcel E.; Nemergut, Edward C.

doi:10.1213/ane.0b013e3181d8a095

Cited by 190 publications

(126 citation statements)

References 17 publications

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“…Studies highlighting the therapeutic potential of methadone, an opioid receptor agonist and NMDA receptor antagonist, are growing in number. A single intraoperative bolus of methadone as opposed to continuous sufentanil infusion, reduced postoperative opioid requirements in patients by almost 50% both 48 and 72 h after surgery [37]. The medical practice of opioid switching is increasingly accepted, and methadone emerges as a key player here.…”

Section: Key Pointsmentioning

confidence: 99%

Opioid-induced hyperalgesia

Bannister

2015

Current Opinion in Supportive &Amp; Palliative Care

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Section: Key Pointsmentioning

confidence: 99%

Opioid-induced hyperalgesia

Bannister

2015

Current Opinion in Supportive &Amp; Palliative Care

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“…17 Desde a descoberta de receptores de opioides na medula em 1970, muitos estudos têm provado a eficácia da morfina epidural. [18][19][20] Nas cirurgias da coluna vertebral, na região posterior, a dor no pós--operatório pode ser intensa por causa da dissecção extensa de partes moles e do descolamento da musculatura paravertebral para obter uma adequada exposição da lâmina, das facetas e dos processos transversos.…”

Section: Discussionunclassified

Nível de dor no pós‐operatório imediato de artrodese lombar após infiltração epidural com sulfato de morfina

Amaral

Vieira

Nakagawa

et al. 2015

Revista Brasileira de Ortopedia

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r e v b r a s o r t o p . 2 0 1 5;5 0(1):72-76 w w w . r b o . o r g . b r Artigo Original Nível de dor no pós-operatório imediato de artrodese lombar após infiltração epidural com sulfato de morfina ଝ informações sobre o artigo Histórico do artigo: Recebido em 15 de dezembro de 2013 Aceito em 24 de fevereiro de 2014 On-line em 23 de janeiro de 2015 Palavras-chave: Morfina Analgesia epidural Dor pós-operatória Artrodese Fusão vertebral r e s u m o Objetivo: Avaliar o nível de dor em pacientes tratados com infusão epidural de sulfato de morfina em Dose única, após procedimento cirúrgico de artrodese lombar. Métodos: Foram submetidos à artrodese lombar posterolateral ou artrodese lombar intersomática por via posterior, em um, dois ou três níveis, 40 pacientes, divididos, prospectivos e randomizados em dois grupos de 20. No primeiro grupo (de estudo) foram infiltrados no espaço epidural, através da área da laminectomia, 2 mg de sulfato de morfina diluídos em 10 mL de soro fisiológico. O segundo grupo (controle) não recebeu analgesia. Os pacientes foram interrogados quanto ao nível de dor, no pré e pós-operatório, com o uso da escala visual analógica (EVA). Resultados: Verificou-se que os pacientes apresentaram uma queda significativa da dor pela EVA. A dor entre o pré e o pós-operatório diminuiu em média 4,7 pontos (p = 0,0001), o que corresponde a 53,2% (p = 0,0001). Conclusão: Aplicação de 2 mg de sulfato de morfina, em dose única epidural, demonstrou ser uma boa técnica na terapia da dor após cirurgia na coluna lombar. © 2014 Sociedade Brasileira de Ortopedia e Traumatologia. Publicado por Elsevier Editora Ltda. Todos os direitos reservados. Immediate postoperative pain level from lumbar arthrodesis following epidural infiltration of morphine sulfate Keywords: Morphine Epidural analgesia Postoperative pain a b s t r a c t Objective: To evaluate the pain level in patients treated with epidural infusion of morphine sulfate in a single dose, after a surgical procedure to perform lumber arthrodesis.Methods: Forty patients underwent posterolateral lumbar arthrodesis or intersomatic lumbar arthrodesis via a posterior route at one, two or three levels. They were prospectively

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“…In the past several years it has been rediscovered as an important component of managing intraoperative and postoperative pain in patients undergoing complex spine surgery [52,53]. In addition to being an opioid agonist, methadone is also an NMDA antagonist, augmenting its ability to manage acute and chronic pain.…”

Section: Methadonementioning

confidence: 99%

“…Thus, methadone is an attractive option in patients undergoing multilevel spine operations or in patients with some degree of opioid tolerance. It is twice as potent as morphine but has a long and highly variable halflife (ranging from 4 to 130 h depending on the dose) [52], which may complicate use in the elderly. Methadone administration should be given careful consideration in the frail elderly.…”

Section: Methadonementioning

confidence: 99%

“…In addition to being difficult to titrate, it has a high potential for drug-drug interaction and is associated with QT prolongation [23]. Best practices may include using a single dose early in the procedure, give half the recommended dose for complex spine surgery (0.1 mg/kg) [52], and anticipate decreased requirements for other opioids during surgery. If pain proves difficult to control after surgery, consultation with a pain specialist is advisable.…”

Section: Methadonementioning

confidence: 99%

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The Elderly Spine Surgery Patient: Pre- and Intraoperative Management of Drug Therapy

Brallier

Deiner

2015

Drugs Aging

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Spine surgery is one of the most common surgeries for adults greater than 65 years of age. Optimizing and caring for the elderly patient presenting for spine surgery requires planning and multidisciplinary input from surgeons, primary care physicians, and anesthesiologists. Controversies exist surrounding appropriate perioperative management of complicated chronic medication regimens and the ideal selection of intraoperative therapy for these patients. In this article we present an overview of the controversies anesthesiologists face as they work with the elderly patient's primary doctor and surgical team to achieve a safe perioperative course. Specifically, we discuss the interaction of geriatric physiology and pathophysiology with medications used in the perioperative period. While care of the geriatric spine surgery patient is nuanced, the anesthesiologist can work together with medical personnel, surgeons, and pharmacy to provide safe and effective care. Key PointsSpine surgery is one of the five most common surgeries for older adults.Optimizing and caring for the elderly patient presenting for spine surgery requires planning and multidisciplinary input from surgeons, primary care physicians, and anesthesiologists.Controversies exist surrounding appropriate perioperative management of complicated medication regimens and the ideal manner in which to care for these patients.Continuation of chronic medications, selection of intraoperative medications, and plan for postoperative pain control are strongly influenced by the surgical plan.

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Intraoperative Methadone Improves Postoperative Pain Control in Patients Undergoing Complex Spine Surgery

Abstract: Perioperative treatment with a single bolus of methadone improves postoperative pain control for patients undergoing complex spine surgery.

Cited by 190 publications

References 17 publications

Opioid-induced hyperalgesia

Opioid-induced hyperalgesia

Nível de dor no pós‐operatório imediato de artrodese lombar após infiltração epidural com sulfato de morfina

The Elderly Spine Surgery Patient: Pre- and Intraoperative Management of Drug Therapy

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