We had a journal club where we discussed this article: Anesthesiology, May 2017; Clinical effectiveness and safety of intraoperative methadone in patients undergoing posterior spinal fusion surgery: a randomized, double-blinded, controlled trial.
- IV Methadone 0.2 mg/kg vs IV hydromorphone 2mg at surgical closure in 2+ level spinal fusion
- Decreased postop IV and opioid requirements and pain scores. Improved patient satisfaction
- Is there a pain service following these patients postoperatively?
- Exclusions: do you include OSA and BMI>45 patients?
- Is ETCO2 and PCA enough to combat respiratory depression on the floor?
- Are any discharged on the same day after receiving this dose — think total knees and single level lamis?
- Will this improve or worsen the opioid epidemic?
- Are surgeons on board with tackling pain multimodally for the benefit of the patient?
- For pain follow-up, are there psychiatry, homeopathy, palliative care, PT, holistic approaches for the patient?
Methadone Dose Conversion Guidelines
Intraop Lidocaine for postop pain
Intraop Ketamine for postop pain
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Br J Clin Pharmacol. 2014 Feb; 77(2): 272–284. Long term outcomes of pharmacological treatments for opioid dependence: does methadone still lead the pack?
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Croat Med J. 2013 Feb; 54(1): 42–48. Risk factors for fatal outcome in patients with opioid dependence treated with methadone in a family medicine setting in Croatia.
J Med Toxicol. 2016 Mar; 12(1): 58–63. Pharmacotherapy of Opioid Addiction: “Putting a Real Face on a False Demon”.
Syst Rev. 2014; 3: 45. Sex differences in outcomes of methadone maintenance treatment for opioid addiction: a systematic review protocol.
APSF: Use of Methadone in the Perioperative Period. Feb 2018
J of Therapeutics and Clinical Risk Management: The challenge of perioperative pain management in opioid-tolerant patients. May 2017.
JCVA: Intraoperative Methadone Is Associated withDecreased Perioperative Opioid Use Without AdverseEvents: A Case-Matched Cohort Study. 2019.
Anesthesiology: Intraoperative Methadone for the Prevention of Postoperative Pain: A Randomized, Double-blinded Clinical Trial in Cardiac Surgical Patients. May 2015. Methadone 0.3mg/kg
Anesthesiology: Intraoperative Methadone in Surgical Patients: A Review of Clinical Investigations. Sept 2019.