Background and Objectives. Methadone is commonly used in chronic pain, but it is not frequently used as an intraoperative analgesic. Several randomized studies have compared intraoperative methadone to morphine regarding postsurgical analgesia, but they have generated conflicting results. The aim of this investigation was to compare the analgesic efficacy of intraoperative methadone to morphine in patients undergoing surgical procedures. Methods. We performed a quantitative systematic review of randomized controlled trials in PubMed, Embase, Cochrane Library, and Google Scholar electronic databases. Meta-analysis was performed using the random effects model, weighted mean differences (WMD), standard deviation, 95% confidence intervals, and sample size. Methodological quality was evaluated using Cochrane Collaboration’s tool. Results. Seven randomized controlled trials evaluating 337 patients across different surgical procedures were included. The aggregated effect of intraoperative methadone on postoperative opioid consumption did not reveal a significant effect, WMD (95% CI) of −0.51 (−1.79 to 0.76), (P=0.43) IV morphine equivalents. In contrast, the effect of methadone on postoperative pain demonstrated a significant effect in the postanesthesia care unit, WMD (95% CI) of −1.11 (−1.88 to −0.33), P=0.005, and at 24 hours, WMD (95% CI) of −1.35 (−2.03 to −0.67), P<0.001. Conclusions. The use of intraoperative methadone reduces postoperative pain when compared to morphine. In addition, the beneficial effect of methadone on postoperative pain is not attributable to an increase in postsurgical opioid consumption. Our results suggest that intraoperative methadone may be a viable strategy to reduce acute pain in surgical patients.
BackgroundMany factors are driving total knee arthroplasty to be performed more commonly as an outpatient (<24 hour discharge) procedure. Nonetheless, the safety of total knee replacements performed in the outpatient setting is not well established when compared with inpatient setting. The purpose of this study is to compare the postoperative outcomes of outpatient and inpatient total knee arthroplasties.MethodsThe 2015 and 2016 American College of Surgeons National Surgical Quality Improvement Program data sets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty. The primary outcome was serious adverse events defined by a composite outcome including: return to operating room, wound-related infection, thromboembolic event, renal failure, myocardial infarction, cardiac arrest requiring cardiopulmonary resuscitation, cerebrovascular accident, use of ventilator >48 hours, unplanned intubation, sepsis/septic shock, and death. Propensity matched analysis was used to adjust for potential confounding covariates.Results1099 patients undergoing outpatient total knee arthroplasty (1% of total cases) were successfully matched to 1099 patients undergoing inpatient surgeries. The composite rate of serious adverse events was greater in outpatient procedures compared with inpatient procedures (3.18% vs 1.36%, p=0.005). In contrast, failure to rescue and readmission rates were not different between groups.ConclusionsOutpatient total knee arthroplasty is associated with a higher composite risk of serious adverse events than inpatient procedures. Anesthesiologists and surgeons should inform patients and discuss this information when obtaining consent for surgery and planning for discharge timing.
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