Methadone and Acute and Chronic Pain Management

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

Questions:

1. Is there a pain service following these patients postoperatively?
2. Exclusions: do you include OSA and BMI>45 patients?
3. Is ETCO2 and PCA enough to combat respiratory depression on the floor?
4. Are any discharged on the same day after receiving this dose — think total knees and single level lamis?
5. Will this improve or worsen the opioid epidemic?
6. Are surgeons on board with tackling pain multimodally for the benefit of the patient?
7. 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

Literature search:

Sys Rev 2014: Effectiveness of opioid substitution treatments for patients with opioid dependence: a systematic review and multiple treatment protocol.

Am j of Pub Health, Aug 2014. Determinants of Increased Opioid-Related Mortality in the United States and Canada, 1990–2013: A Systematic Review.

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?

PLoS One. 2014; 9(11): e112328. Methadone Induction in Primary Care for Opioid Dependence: A Pragmatic Randomized Trial (ANRS Methaville).

Curr Psychiatry Rev. 2014 May; 10(2): 156–167. Genetics of Opioid Dependence: A Review of the Genetic Contribution to Opioid Dependence. 

Drug Alcohol Depend. 2016 Mar 1; 160: 112–118. Methadone, Buprenorphine and Preferences for Opioid Agonist Treatment: A Qualitative Analysis. 

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.

Update 12/4/2019

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.

From J Therapeutics and Clinical Risk Management. 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, May 2015

Anesthesiology: Intraoperative Methadone in Surgical Patients: A Review of Clinical Investigations. Sept 2019.

Anesthesiology, Sept 2019

Anesthesiology, Sept 2019