- A recent paradigm shift in anesthesia and perioperative opioid use addresses the desires to use less intraoperative opioid, diminish postoperative pain and oral opioid use, and decrease post discharge opioid prescribing, which remains widespread and problematic.
- Methadone is a highly effective and opioid-sparing perioperative opioid. Intraoperative methadone, compared with shorter-duration opioids (morphine, fentanyl, hydromorphone), results in 30 to 40% less postoperative pain and opioid use, and greater patient satisfaction.
- While methadone is now increasingly used for inpatient surgery, little is known about methadone in outpatient surgery including clinical benefit, potential side effects, utility, and appropriate dose.
- In this study, the authors conducted a single-center, randomized, double-blind, parallel-group, dose-escalation, dose-finding study to determine the feasibility of single-dose intraoperative methadone for next-day discharge outpatient surgery. The authors also sought to identify an optimally analgesic and well-tolerated dose and explore whether it would result in less postoperative opioid use than shorter-acting opioids.
- Patients received methadone as a single dose upon arrival in the operating room and were randomized to receive either single-dose methadone or usual practice with intraoperative short-duration opioid. The initial cohort of 20 patients in the methadone arm received 0.1 mg/kg ideal body weight, and successive cohorts received 0.2, 0.25 and 0.3 mg/kg ideal body weight.
- Following PACU admission, patients were regularly assessed for pain, sedation, and adverse events until discharge.
- Patients were then followed for 30 days after surgery, recording their daily average pain and opioid analgesic use, as well as quality of recovery metrics and opioid side effects.
- In-hospital opioid use was statistically lower among patients receiving methadone versus those receiving short-duration opioids. Although there was high interindividual variability, there was a trend toward decreased home pain and opioid use in patients receiving methadone.
- The authors concluded that for adults undergoing next-day discharge outpatient surgery, 0.25 mg/kg ideal body weight of methadone is the intraoperative dose appearing to best combine opioid sparing, analgesia, minimal adverse events, and advantages compared with short-duration opioids.
Summary of "Intraoperative Methadone in Next-day Discharge Outpatient Surgery: A Randomized, Double-blinded, Dose-finding Pilot Study"
Summary published January 20, 2025
