In the Literature

Summary of "Scheduled methadone reduces overall opioid requirements after pediatric posterior spinal fusion: A single center retrospective case series"

Summary published January 12, 2023

Summary by Bommy Mershon, MD

Pediatric Anesthesia | October 2022

Mok V, Sweetman S, Hernandez B, Casias T, Hylton J, Krause BM, Noonan KJ, Walker BJ. Scheduled methadone reduces overall opioid requirements after pediatric posterior spinal fusion: A single center retrospective case series. Paediatr Anaesth. 2022 Oct;32(10):1159-1165. doi: 10.1111/pan.14526. Epub 2022 Jul 20. PMID: 35816392.

doi: https://doi.org/10.1111/pan.14526

  • Posterior spinal fusions are associated with significant postoperative pain.
  • In this retrospective chart review of all patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis at one institution, the authors compared opioid use over the first 72 hours after surgery between three groups: 1) a hydromorphone PCA, 2) preincisional methadone and a hydromorphone PCA, and 3) preincisional methadone and scheduled postoperative methadone.
  • Of the three groups, a regimen of preincisional methadone and scheduled postoperative doses of methadone for postoperative analgesia resulted in a 45% reduction in opioid usage when compared to the PCA based strategies.
  • Scheduled methadone as compared to hydromorphone PCA, achieved equivalent analgesia after posterior spine fusions in pediatric patients.
  • Subsequently at this institution, they were able to remove PCAs and acute pain service consultations and showed a decrease in length of stay from 5 to 3 days.