Safety profile of intraoperative methadone for analgesia after major spine surgery: An observational study of 1,478 patients

Dunn, Lauren K.; Yerra, Sandeep; Fang, Shenghao; Hanak, Mark F.; Leibowitz, Maren K.; Alpert, Salome B; Tsang, Siny; Durieux, Marcel E.; Nemergut, Edward C.; Naik, Bhiken I.

doi:10.5055/jom.2018.0435

Cited by 37 publications

(24 citation statements)

References 11 publications

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“…A retrospective study of 1478 spine surgery patients who received intraoperative methadone demonstrated a relatively high incidence of side effects: 44% of patients presented with nausea/vomiting, 36.8% had respiratory depression, and 80% had hypoxemic events postoperatively. 34 However, the study lacked a comparator group, and methadone dose was not standardized.…”

Section: Conmentioning

confidence: 99%

Pro-Con Debate: Role of Methadone in Enhanced Recovery After Surgery Protocols—Superior Analgesic or Harmful Drug?

D’Souza

Esfahani²,

Dunn

2023

Anesthesia &Amp; Analgesia

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Enhanced recovery after surgery (ERAS) protocols are standardized and designed to provide superior analgesia, reduce opioid consumption, improve patient recovery, and reduce hospital length of stay. Yet, moderate-to-severe postsurgical pain continues to afflict over 40% of patients and remains a major priority for anesthesia research. Methadone administration in the perioperative setting may reduce postoperative pain scores and have opioid-sparing effects, which may be beneficial for enhanced recovery. Methadone possesses a multimodal profile consisting of µ-opioid agonism, N-methyl-d-aspartate (NMDA) receptor antagonism, and reuptake inhibition of serotonin and norepinephrine. Furthermore, it may attenuate the development of chronic postsurgical pain. However, caution is advised with perioperative use of methadone in specific high-risk patient populations and surgical settings. Methadone's wide pharmacokinetic variability, opioid-related adverse effects, and potential negative impact on cost-effectiveness may also limit its use in the perioperative setting. In this PRO-CON commentary article, the authors debate whether methadone should be incorporated in ERAS protocols to provide superior analgesia with no increased risks.

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Section: Conmentioning

confidence: 99%

Pro-Con Debate: Role of Methadone in Enhanced Recovery After Surgery Protocols—Superior Analgesic or Harmful Drug?

D’Souza

Esfahani²,

Dunn

2023

Anesthesia &Amp; Analgesia

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“… 17 Moreover, a single larger dose of intraoperative methadone in adolescents had a high incidence of respiratory depression after PSF. 12 A single dose of intraoperative methadone, as part of a multimodal analgesia regimen, improved pain scores with modest shortening in LOS without significant reduction in opioid consumption on POD 1 and 2. 18 …”

Section: Introductionmentioning

confidence: 99%

“… 10 , 11 Some studies suggest postoperative respiratory monitoring is prudent due to high incidence (36.8%) of respiratory depression when used with PCA hydromorphone. 12 However, there is limited evidence for the effectiveness and safety of perioperative methadone in children. Methadone has been effective for postoperative pain in younger children and those undergoing Nuss procedure for surgical correction of pectus excavatum.…”

Section: Introductionmentioning

confidence: 99%

Methadone-based Multimodal Analgesia Provides the Best-in-class Acute Surgical Pain Control and Functional Outcomes With Lower Opioid Use Following Major Posterior Fusion Surgery in Adolescents With Idiopathic Scoliosis

Myung

Packiasabapathy

et al. 2020

Pediatric Quality &Amp; Safety

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Introduction: Posterior spinal fusion for idiopathic scoliosis is extremely painful, with no superior single analgesic modality. We introduced a methadone-based multimodal analgesia protocol, aiming to decrease the length of hospital stay (LOS), improve pain control, and decrease the need for additional opioids. Methods: We analyzed 122 idiopathic scoliosis patients with posterior instrumented spinal fusion. They were matched by age, sex, surgeon, and the number of levels fused before and after the implementation of the new protocol. This analysis included 61 controls (intrathecal morphine, gabapentin, intravenous opioids, and adjuncts) and 61 patients on the new protocol (scheduled methadone, methocarbamol, ketorolac/ibuprofen, acetaminophen, and oxycodone with intravenous opioids as needed). The primary outcome was LOS. Secondary outcomes included pain scores, total opioid use (morphine milligram equivalents), time to a first bowel movement, and postdischarge phone calls. Results: New protocol patients were discharged earlier (median LOS, 2 days) compared with control patients (3 days; P < 0.001). Total inpatient morphine consumption was lower in the protocol group ( P < 0.001). Pain scores were higher in the protocol group on the day of surgery, similar on postoperative day (POD) 1, and lower by POD 2 ( P = 0.01). The new protocol also reduced the median time to first bowel movement ( P < 0.001), and the number of postdischarge pain-related phone calls ( P < 0.006). Conclusion: Methadone-based multimodal analgesia resulted in significantly lower LOS compared with the conventional regimen. It also provided improved pain control, reduced total opioid consumption, and early bowel movement compared with the control group.

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“…Other adverse effects reported as secondary outcomes included hypoxemia (81%), reintubation (2%), naloxone use (2%), hypotension (50%), cardiac arrhythmias (31%), and QTc prolongation (57%) (category B2-E evidence). 113…”

Section: Intraoperative Managementmentioning

confidence: 99%

Practice Advisory for Preoperative and Intraoperative Pain Management of Cardiac Surgical Patients: Part 2

Makkad

Heinke

Sheriffdeen

et al. 2023

Anesthesia &Amp; Analgesia

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Patients after cardiac surgery experience moderate to severe pain in the immediate postoperative period as a result of surgical interventions, such as incision, sternotomy, sternal retraction, pericardiotomy, tissue dissection, and the presence of chest tubes. 1 Poorly controlled acute pain increases suffering, cardiovascular stress, and respiratory complications and may develop into persistent postoperative pain, which adversely affects patients' daily activities, psychological well-being, and quality of life. 2

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Safety profile of intraoperative methadone for analgesia after major spine surgery: An observational study of 1,478 patients

Abstract: Mild-moderate respiratory depression is observed following a one-time dose of intraoperative methadone, and monitoring in an appropriate postoperative setting is recommended.

Cited by 37 publications

References 11 publications

Pro-Con Debate: Role of Methadone in Enhanced Recovery After Surgery Protocols—Superior Analgesic or Harmful Drug?

Pro-Con Debate: Role of Methadone in Enhanced Recovery After Surgery Protocols—Superior Analgesic or Harmful Drug?

Methadone-based Multimodal Analgesia Provides the Best-in-class Acute Surgical Pain Control and Functional Outcomes With Lower Opioid Use Following Major Posterior Fusion Surgery in Adolescents With Idiopathic Scoliosis

Practice Advisory for Preoperative and Intraoperative Pain Management of Cardiac Surgical Patients: Part 2

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