Methadone reduces postoperative opioid needs

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Intraoperative methadone appears to reduce the need for postoperative opioids among patients undergoing spinal surgery.

Acute pain after spinal fusion surgery can be particularly difficult to manage and patients undergoing complex spinal surgery often present with chronic neuropathic pain and dependence on oral opioid medication.

Findings from a new study suggest intraoperative methadone could lead to a reduced need for postoperative opioids in this patient population.

As part of the study, published in Anesthesiology , 115 patients undergoing posterior spinal fusion surgery were randomised to receive either methadone 0.2mg/kg at the start of surgery or hydromorphone 2mg at surgical closure. The primary outcome was postoperative IV hydromorphone use.

Median hydromorphone use was reduced in the methadone group, not only on postoperative day 1, but also on postoperative days 2 and 3. Pain scores at rest, with movement, and with coughing were lower in the methadone group in 21 of 27 assessments. Overall satisfaction with pain management was also higher in the methadone group.

“This is a new application for an old pain medication that offers hope for reducing the development of acute pain in the first few days after surgery, as well as chronic postoperative pain and the need for opioid medications following discharge from the hospital,” said Dr. Glenn S. Murphy, lead study author.

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