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ORIGINAL ARTICLE   Free accessfree

Minerva Anestesiologica 2019 October;85(10):1053-61

DOI: 10.23736/S0375-9393.19.13136-7


language: English

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

Kathleen BASTIAN 1, Philipp K. BUEHLER 2, Dovile SLIZYTE 1, Christoph A. RÜST 3, Katharina TOFT 4, Wolfgang STUDER 1, Leopold LECHELER 5, José AGUIRRE 6, Martin SIEGEMUND 1, 7, Alexa HOLLINGER 1

1 Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland; 2 Department of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland; 3 Institute of Primary Care, University of Zurich, Zurich, Switzerland; 4 Department for Anaesthesia, Intensive Care and Emergency Medicine, See Hospital, Horgen, Switzerland; 5 SOS Doctors, Zurich, Switzerland; 6 Department of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland; 7 Medical Faculty, University of Basel, Basel, Switzerland

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.

KEY WORDS: Pain, postoperative; Anesthesia, general; Analgesia, patient-controlled

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