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

Effect of intraoperative methadone vs other opioids on postoperative outcomes: a meta-analysis of randomized controlled studies

“…Eight RCTs 1,3,8,14,16,21,22,25 (n = 622) reported on pain scores within 24 hours. The pain score were significantly lower in the methadone group when compared with other opioids combined together (8 studies, n= 622, −0.49 [−0.74, −0.23], P = 0.002, I 2 = 55%) (Fig.…”

“…Although there is growing evidence that methadone may provide superior outcomes with respect to postoperative analgesic requirement and reduced pain scores, more studies are required. However, recently published high-quality studies by Murphy et al, 21,22 Gottschalk et al, 8 and Bastian et al 1 do provide promising results. Moreover, consistency of protocols and larger sample size are required to make accurate and meaningful interpretations.…”

“…However, the results of our meta-analysis do not support this conclusion. The difference in conclusion may be due to a number of reasons including exclusion of studies which had different postoperative analgesic protocol between the groups, inclusion of 3 additional studies 1,3,14 with an additional 270 patients, and obtaining of additional accurate data from study authors 1,8,21,22 in our meta-analysis. In addition, subgroup analysis suggests methadone may be superior over some opioids but not all other opioids.…”

“…Four RCTs (n 5 431) reported on total postoperative opioid consumption by patients in both the methadone and other opioids control groups. Laur et al, 14 Bastian et al, 1 and Murphy et al 21,22 reported postoperative opioid consumption at 24 hours, 72 hours, and total postoperative periods, respectively. There was a no statistically significant reduction in opioid consumption postoperatively in the methadone group (4 studies, n 5 431, 20.39, [20.87, 0.10].…”

A year in review in Minerva Anestesiologica 2020. Anesthesia, analgesia, and perioperative medicine

“…recently, Bastian et al suggested that a single dose of methadone could be more effective than fentanyl to reduce postoperative morphine needs. 126 they randomized 160 patients to receive 0.03 mg/kg fentanyl or 0.2 mg/ kg methadone iV before general anesthesia induction for surgery in which they expected severe PoP. Unlike previous studies, they found that a single dose of methadone could dramatically decrease morphine consumption in the following 72 hours, even if intraoperative fentanyl consumption was similar in the two groups.…”