ORIGINAL ARTICLE   Free

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

DOI: 10.23736/S0375-9393.19.13136-7

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

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