The perioperative combination of methadone and ketamine reduces post‐operative opioid usage compared with methadone alone

Abstract

Perioperative ketamine-ME combination significantly decreased opioid consumption by PCA.

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

“…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.…”

Prevention and Treatment of Postoperative Pain after Lumbar Spine Procedures: A Systematic Review

“…The 29 RTCs that tested therapies administered during the intraoperative period included systemic pharmacological therapies (19 studies) [48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66] and locoregional anesthetic drugs (10 studies) [67][68][69][70][71][72][73][74][75][76] (see Table 3).…”

“…[64][65][66] Of the 5 RCTs that tested dexmedetomidine, [48][49][50][51][52] in 2 the use of dexmetomedine did not guarantee lower postoperative pain scores but was able to reduce opioid consumption when compared to placebo or midazolam; in 2 other studies it did not reduce postoperative pain when compared to the control group, and in 1 it was more effective than remifentanil in reducing postoperative pain and patient-controlled analgesia (PCA) consumption. Of the 5 RCTs that tested ketamine, [53][54][55][56][57] 4 studies proved that this drug can reduce opioid consumption but not pain scores when compared to placebo, while 1 study 54 found that low-dose ketamine was associated with lower pain scores but higher opioid consumption when compared to fentanyl. The 2 RCTs that tested tramadol found that it did not reduce pain scores but it was more effective than placebo and less effective than fentanyl in reducing opioid consumption.…”

Perioperative Ketamine for Acute Postoperative Analgesia: The Mayo Clinic—Florida Experience

“…Studies have shown low-dose intravenous (IV) ketamine infusions to be a helpful adjunct in the treatment of postoperative pain especially in patients with chronic preoperative pain. 1,2,[6][7][8][9][10][11] Similarly, the drug has been shown to decrease discomfort in several chronic pain syndromes and conditions, such as complex regional pain syndrome, central neuropathic pain, peripheral neuropathic pain, postherpetic neuralgia, fibromyalgia, and cancerrelated pain. 12 Perioperatively, ketamine is primarily given intravenously; however, it is also effective via intramuscular, oral, and rectal routes.…”