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A preoperative single dose of methadone for moderate-to-severely painful surgery reduces postoperative morphine consumption.

Abstract：

BACKGROUND:Data from patient questionnaires reveal that the intensity of postoperative pain is widely underestimated. Insufficient pain control may contribute to impaired short- and long-term outcome. Preoperative administration of methadone might potentially improve postoperative pain control due to its long pharmacological half-life. METHODS:The aim of this study was to evaluate the effect of a single dose of methadone administered at anesthesia induction on postoperative analgesic requirements in ASA I-III patients after moderate-to-severely painful surgery scheduled for ≥90 minutes. Patients were randomized to receive either a single dose of methadone (0.2 mg/kg) or fentanyl (standard, 0.003 mg/kg) intravenously (IV) at anesthesia induction. For postoperative pain control, all study patients were accommodated with morphine on the basis of patient-controlled analgesia (PCA). RESULTS:Per-protocol analysis revealed that the median cumulative morphine consumption was significantly lower in patients receiving a single dose of methadone, in the Postanesthesia Care Unit (0 mg vs. 7 mg of morphine, P<0.01) and during the first 72 hours after surgery (19 mg vs. 35 mg of morphine, P<0.05 for all days). Fentanyl consumption during surgery (0.25 mg [0.1-0.425 mg] in the study group vs. 0.3 mg [0.15-0.45 mg] in the control group, P=0.4499) was comparable among groups. Median pain scores at rest and in motion, and patient satisfaction were also similar in both groups (95.7% vs. 89.3% of patients were satisfied in the study and control group, respectively) during follow-up on postoperative days 1-3. CONCLUSIONS:A single dose of methadone administered at anesthesia induction prior to moderate-to-severely painful surgery is a possible strategy to reduce postoperative morphine consumption.

journal_name

Minerva Anestesiol

journal_title

Minerva anestesiologica

authors

Bastian K,Buehler PK,Slizyte D,Rüst CA,Toft K,Studer W,Lecheler L,Aguirre J,Siegemund M,Hollinger A

doi

10.23736/S0375-9393.19.13136-7

subject

Has Abstract

pub_date

2019-10-01 00:00:00

pages

1053-1061

issue

eissn

0375-9393

issn

1827-1596

pii

S0375-9393.19.13136-7

journal_volume

pub_type

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A preoperative single dose of methadone for moderate-to-severely painful surgery reduces postoperative morphine consumption.