Anesthesia Journal - Clinical Effectiveness and Safety of Intraoperative Methadone in Patients Undergoing Posterior Spinal Fusion Surgery: A Randomized, Double-blinded, Controlled Trial PDF
Glenn S. Murphy, M.D.; Joseph W. Szokol, M.D.; Michael J.
Avram, Ph.D.; Steven B. Greenberg, M.D.; Torin D. Shear, M.D.; Mark A. Deshur,
M.D.; Jeffery S. Vender, M.D.; Jessica Benson, B.S.; Rebecca L. Newmark, B.A.
Abstract
Background: Patients undergoing spinal fusion surgery often
experience severe pain during the first three postoperative days. The aim of
this parallel-group randomized trial was to assess the effect of the
long-duration opioid methadone on postoperative analgesic requirements, pain
scores, and patient satisfaction after complex spine surgery.
Methods: One hundred twenty patients were randomized to
receive either methadone 0.2 mg/kg at the start of surgery or hydromorphone 2 mg at surgical closure. Anesthetic care was
standardized, and clinicians were blinded to group assignment. The
primary outcome was intravenous hydromorphone consumption on postoperative day
1. Pain scores and satisfaction with pain management were measured at
postanesthesia care unit admission, 1 and 2 h postadmission, and on the mornings and
afternoons of postoperative days 1 to 3.
Results: One hundred fifteen patients were included in the
analysis. Median hydromorphone use was reduced in the methadone group not only
on postoperative day 1 (4.56 vs. 9.90 mg) but also on postoperative days 2
(0.60 vs. 3.15 mg) and 3 (0
vs. 0.4 mg; all P< 0.001). Pain scores at rest, with
movement, and with coughing were less in the methadone group at 21 of 27
assessments (all P = 0.001 to < 0.0001). Overall satisfaction with pain
management
was higher in the methadone group than in the hydromorphone group until the
morning of postoperative day 3 (all P = 0.001 to < 0.0001).
Conclusions: Intraoperative methadone administration reduced
postoperative opioid requirements, decreased pain scores, and improved patient
satisfaction with pain management.
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