Intraoperative Methadone in Same-Day Ambulatory Surgery: A Randomized, Double-Blinded, Dose-Finding Pilot Study

Anesthesia and Analgesia
Helga KomenEvan D Kharasch

Abstract

Approximately 50 million US patients undergo ambulatory surgery annually. Postoperative opioid overprescribing is problematic, yet many patients report inadequate pain relief. In major inpatient surgery, intraoperative single-dose methadone produces better analgesia and reduces opioid use compared with conventional repeated dosing of short-duration opioids. This investigation tested the hypothesis that in same-day ambulatory surgery, intraoperative methadone, compared with short-duration opioids, reduces opioid consumption and pain, and determined an effective intraoperative induction dose of methadone for same-day ambulatory surgery. A double-blind, dose-escalation protocol randomized 60 patients (2:1) to intraoperative single-dose intravenous methadone (initially 0.1 then 0.15 mg/kg ideal body weight) or conventional as-needed dosing of short-duration opioids (eg, fentanyl, hydromorphone; controls). Intraoperative and postoperative opioid consumption, pain, and opioid side effects were assessed before discharge. Patient home diaries recorded pain, opioid use, and opioid side effects daily for 30 days postoperatively. Primary outcome was in-hospital (intraoperative and postoperative) opioid use. Secondary outcomes were 30 days...Continue Reading

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Citations

Feb 15, 2020·Anesthesiology·Evan D KharaschJ David Clark
May 17, 2019·Anesthesiology·Glenn S Murphy, Joseph W Szokol
Oct 9, 2019·Minerva anestesiologica·Rossella Garra, Fabio Sbaraglia
Jun 22, 2020·CNS Drugs·Denise Kreutzwiser, Qutaiba A Tawfic
Nov 20, 2019·Anesthesia and Analgesia·Glenn S MurphyEdward J Mascha
Feb 26, 2021·Anesthesiology·Evan D Kharasch, J David Clark
Apr 6, 2020·Journal of Perianesthesia Nursing : Official Journal of the American Society of PeriAnesthesia Nurses·Rachel C Wolfe
Feb 23, 2021·The Annals of Pharmacotherapy·Adina PetrosanElena Gutman
Mar 20, 2021·Anesthesiology·Evan D Kharasch, J David Clark
Aug 18, 2020·Journal of the American College of Surgeons·Q Lina HuChristine Laronga
Mar 30, 2021·Pain Management·Sylvia H WilsonArvind Chandrakantan
Apr 4, 2021·Healthcare·Sara J HylandRobert K Cleary
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