Intraoperative Methadone Reduces Pain and Opioid Consumption in Acute Postoperative Pain

Abstract Background The association of psychological factors with postoperative pain has been well documented. The incorporation of psychoeducational intervention into a standard analgesia protocol seems to be an attractive approach for the management of acute postoperative pain. Our study aimed to evaluate the impact of psychoeducational intervention on acute postoperative pain in pulmonary nodule (PN) patients treated with thoracoscopic surgery. Methods In this study, 76 PN patients treated with thoracoscopic surgery and intravenous patient-controlled analgesia (IV-PCA) plus psychoeducational evaluation and intervention were selected as the psychoeducational intervention group (PG). Another 76 PN patients receiving IV-PCA without psychoeducational intervention after thoracoscopic surgery, treated as the control group (CG), were identified from the hospital database and matched pairwise with PG patients according to age, sex, preoperative body mass index (BMI), opioid medications used for IV-PCA and the educational attainment of patients. Results The most common psychological disorders were anxiety and interpersonal sensitivity, which were recorded from 82.9% (63/76) and 63.2% (48/76) of PG patients. The numerical rating scale (NRS) pain scores of the PG patients were significantly lower than those of the CG patients at 2 and 24 h after surgery (P < 0.001). Total opioid consumption for acute postoperative pain in the PG was 52.1 mg of morphine equivalent, which was significantly lower than that (67.8 mg) in the CG (P = 0.038). PG patients had a significantly lower incidence of rescue analgesia than CG patients (28.9% vs. 44.7%, P = 0.044). Nausea/vomiting was the most common side effect of opioid medications, recorded for 3 (3.9%) PG patients and 10 (13.2%) CG patients (P = 0.042). In addition, no significant difference was observed between PG and CG patients in terms of grade 2 or higher postoperative complications (10.5% vs. 17.1%, P = 0.240). Conclusions Psychoeducational intervention for PN patients treated with thoracoscopic surgery resulted in reduced acute postoperative pain, less opioid consumption and fewer opioid-related side effects.

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Faculty Opinions recommendation of Intraoperative Methadone Reduces Pain and Opioid Consumption in Acute Postoperative Pain: A Systematic Review and Meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736545309.793576187 ◽

2020 ◽

Author(s):

Winfried Meissner

Keyword(s):

Systematic Review ◽

Postoperative Pain ◽

Meta Analysis ◽

Opioid Consumption ◽

Acute Postoperative Pain

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Intraoperative Methadone Use in Cardiac Surgery: A Systematic Review

Pain Medicine ◽

10.1093/pm/pnab269 ◽

2021 ◽

Author(s):

Veronika A Lobova ◽

John M Roll ◽

Marshall L C Roll

Keyword(s):

Cardiac Surgery ◽

Postoperative Pain ◽

Adverse Effects ◽

Quality Assessment ◽

Standard Of Care ◽

Risk Of Bias ◽

Opioid Consumption ◽

Cochrane Library ◽

Acute Postoperative Pain ◽

Manual Search

Abstract Objective To investigate the effects of intraoperative methadone to standard of care opioids such as fentanyl and morphine on pain scores, opioid consumption, and adverse effects in adults undergoing cardiothoracic surgery. Methods The literature was reviewed on PubMed, Embase, Cochrane Library, and Google Scholar, followed by a manual search using reference lists of the identified articles. Search terms included a combination of intraoperative methadone, methadone, and cardiac surgery. Our review includes four studies published between 2011 and 2020. Quality assessment of the studies was performed. Results The initial search identified 715 articles with 461 duplicates removed, and 236 eliminated based on inclusion and exclusion criteria. Eighteen articles underwent full-text review. Four studies evaluating a total of 435 patients with various cardiothoracic procedures were included in this review. We found that intraoperative methadone decreases acute postoperative pain and reduces postoperative opioid consumption in the first 24 postoperative hours in patients who received 0.1-0.3 mg/kg intraoperative methadone in comparison to morphine and fentanyl. No difference was found in adverse effects between the groups. Quality assessment of the studies showed a low risk of bias in three of the randomized controlled trials and a high risk of bias in the retrospective review because of the baseline confounding bias in the study design. Conclusions Intraoperative methadone use reduces acute postoperative pain and lowers opioid consumption in comparison to morphine and fentanyl. Initial results suggest that methadone may be an equivalent opioid to be administered during cardiothoracic procedures to reduce acute post-surgical pain, though further research is warranted.

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