Comparison of morphine and methadone for prevention of postoperative pain in 3- to 7-year-old children

Berde, Charles B.; Beyer, Judith; Bournaki, Marie-Christine; Levin, Cynthia; Sethna, Navil F.

doi:10.1016/s0022-3476(05)81054-6

Cited by 148 publications

(71 citation statements)

References 15 publications

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“…Few reports have described the use of methadone in children. Most of these studies were conducted in the acute postoperative pain setting, 8 while only three described the use of oral methadone in children with chronic pain. 18,23,24 In contrast to adults, however, pharmacokinetic studies of methadone in children are not available.…”

Section: Discussionmentioning

confidence: 99%

Methadone is safe for treating hospitalized patients with severe pain

Shir

Rosen

Zeldin

et al. 2001

Can J Anesth/J Can Anesth

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Purpose: Methadone is still regarded as a second line opioid for patients suffering from severe pain, and is rarely used in hospitalized patients. The infrequent use of methadone is probably due to its long plasma half-life that could lead to accumulation and toxicity. In the present study we report that clinically effective analgesic doses of methadone, given either epidurally or orally, can be used safely for prolonged treatment in hospitalized patients.Clinical features: Over a five-year period we administered methadone at Hadassah Hospital in Jerusalem to 3,954 in-patients with severe pain, 12% of whom were younger than 17 yr. Satisfactory pain relief was recorded in more than 85% of the patients. None of the patients treated with oral methadone developed serious side effects. Three patients, treated with epidural methadone (0.09%), developed a clinically significant respiratory depression. In all three cases, epidural pump failure or pump misprogramming resulted in methadone overdose. None of the children or adults treated with methadone developed addiction during hospitalization.Conclusion: Based on its analgesic properties and marked safety profile, we suggest that methadone could be added to the analgesic armamentarium of in-hospital health-care providers. Moreover, methadone could serve as the opioid of first choice in some inpatient populations. Conclusion : Étant donné ses propriétés analgésiques et son remarquable profil d'innocuité, nous croyons que la méthadone pourrait s'ajouter à l'arsenal thérapeutique des patients hospitalisés. Elle peut aussi servir d'opioïde de premier choix chez certains patients hospitalisés.NDERTREATMENT of pain is common in hospitalized patients, children and adults. 1 , 2 It is estimated that 50% of in-patients suffer substantial pain at some time. 2 Although patients undergoing surgical procedures are more likely to suffer pain during hospitalization, more than 20% of non-surgical patients report substantial pain while in hospital. 2 , 3 Opioids are the mainstay of therapy for pain due to malignancy and an important adjuvant in patients with pain of non-cancerous etiology. Nevertheless, almost 50% of in-patients that do receive opioids for their pain report moderate to severe pain. 4 Methadone is a potent, highly lipid soluble and protein bound synthetic opioid, with a rapid onset of analgesia, large volume of distribution and prolonged half-life. 5 While its analgesic effect during chronic treatment does not exceed 12 hr, its plasma half-life could be as long as 72 hr. 6 Although favourable results REGIONAL ANESTHESIA AND PAIN

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Section: Discussionmentioning

confidence: 99%

Methadone is safe for treating hospitalized patients with severe pain

Shir

Rosen

Zeldin

et al. 2001

Can J Anesth/J Can Anesth

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“…Determining appropriate efficacy or benefit measures is a common problem for the design of all studies on the control of perioperative pain. 12,76,[83][84][85] Classic paradigms and study designs for perioperative pain evaluation in adults (pain from third-molar extraction 86,87 ) and older children (using a patient-controlled analgesia device with cumulative morphine use and the opioid-sparing effects as outcomes 88,89 ) are not applicable for the neonatal age group. Creative study designs and novel outcomes, therefore, may need to be considered for studies that investigate neonatal anesthesia or analgesia.…”

Section: Procedural Painmentioning

confidence: 99%

“…One must consider the lack of validated pain-assessment tools to evaluate ongoing pain and discomfort in mechanically ventilated preterm neonates. 54,75,76,88,116,123,124 Numerous randomized, controlled trials have evaluated pain control in mechanically ventilated newborns, but many have been underpowered. 19,39,102,[125][126][127][128] Two recent appropriately powered studies enrolled a total of 1048 neonates and demonstrated no differences in the incidence of severe intraventricular hemorrhage, periventricular leukomalacia, or death outcomes between the ventilated infants who received morphine or placebo infusions.…”

Section: Procedural Painmentioning

confidence: 99%

Summary Proceedings From the Neonatal Pain-Control Group

et al. 2006

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Recent advances in neurobiology and clinical medicine have established that the fetus and newborn may experience acute, established, and chronic pain. They respond to such noxious stimuli by a series of complex biochemical, physiologic, and behavioral alterations. Studies have concluded that controlling pain experience is beneficial with respect to short-term and perhaps long-term outcomes. Yet, pain-control measures are adopted infrequently because of unresolved scientific issues and lack of appreciation for the need for control of pain and its long-term sequelae during the critical phases of neurologic maturation in the preterm and term newborn. The neonatal pain-control group, as part of the Newborn Drug Development Initiative (NDDI) Workshop I, addressed these concerns. The specific issues addressed were (1) management of pain associated with invasive procedures, (2) provision of sedation and analgesia during mechanical ventilation, and (3) mitigation of pain and stress responses during and after surgery in the newborn infant. The cross-cutting themes addressed within each category included (1) clinical-trial designs, (2) drug prioritization, (3) ethical constraints, (4) gaps in our knowledge, and (5) future research needs. This article provides a summary of the discussions and deliberations. Full-length articles on procedural pain, sedation and analgesia for ventilated infants, perioperative pain, and study designs for neonatal pain research were published in Clinical Therapeutics (June 2005).www.pediatrics.org/cgi

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“…Methadone is available in a liquid form, so it can be titrated to effect in children easily. The analgesic half-life of methadone may be increased in children and adolescents, with many needing only two or three doses per day for adequate pain relief rather than the traditional dosing every 6 hours [127,128]. Additional pediatric dosing guidelines are provided in Table 2.…”

Section: Pharmacologic Managementmentioning

confidence: 99%