Intraoperative use of methadone improves control of postoperative pain in morbidly obese patients: a randomized controlled study

Abstract

ObjectivesSurgical patients still commonly experience postoperative pain. With the increasing prevalence of obesity, there is a growing demand for surgical procedures by this population. Intraoperative use of methadone has not been well assessed in this population.Materials and methodsPatients with a body mass index of 35 kg/m2 or more undergoing bariatric surgery were randomly assigned to receive either fentanyl (group F) or methadone (group M) in anesthesia induction and maintenance. The primary outcome was morphine consumption during the first 24 hours after surgery through a patient-controlled analgesia device. Secondary outcomes were pain scores at rest and while coughing, opioid related side effects, and patient satisfaction. The patients were also evaluated 3 months after surgery for the presence of pain, dysesthesia, or paresthesia at surgical site.ResultsPostoperative morphine consumption was significantly higher for patients receiving fentanyl than methadone during the postoperative period at 2 hours (mean difference [MD] 6.4 mg; 95% CI 3.1–9.6; P<0.001), 2–6 hours (MD 11.4 mg; 95% CI 6.5–16.2; P<0.001), 6–24 hours (MD 10.4 mg; 95% CI 5.0–15.7; P<0.001), and 24–48 hours (MD 14.5 mg; 95% CI 3.9–25.1; P=0.01). Patients from group F had higher pain scores until 24 hours postoperatively, higher incidence of nausea and vomiting, lower satisfaction, and more evoked pain at surgical scar at the 3-month postoperative evaluation than group M.ConclusionIntraoperative methadone can safely lower postoperative opioid consumption and improve postoperative pain scores compared with fentanyl in morbidly obese patients.

Intra‐operative methadone effect on quality of recovery compared with morphine following laparoscopic gastroplasty: a randomised controlled trial

“…These findings are in accordance with results published by Machado et al. [14], who showed a significant reduction in rescue morphine use up to 48 h in patients who received methadone after open bariatric surgery, when compared with intra‐operative fentanyl. Our results are also in line with a published meta‐analysis of 13 clinical trials that showed that intra‐operative methadone reduced consumption of opioids up to 72 h after surgery [27].…”

“…[28], which provides more trustworthy data on the pain felt by patients in the period immediately after surgery than pain scores assessed at fixed times. Other authors have also observed lower pain scores early on in PACU for patients who received methadone after open bariatric surgery, compared with fentanyl [14] and in spinal surgery, compared with hydromorphone [16]. Furthermore, Machado et al.…”

“…However, its effect on patient‐centred outcomes such as quality of recovery has not yet been studied. Moreover, to date, there is just one small clinical trial in obese patients undergoing bariatric surgery [14].…”

Comparison effect of local subcutaneous tramadol and methadone in post laparotomy pain control

“…Both drugs had considerable effects when used intramuscularly, intravenously and intraarticular to relieve postoperative pain (9)(10)(11)(12). Tramadol could also reduce pain when used subcutaneously around the wound alone or in combination with ketamine (8).…”

Side effect profiles of different opioids in the perioperative setting: are they different and can we reduce them?

“…Interestingly, at 3 months after operation, patients who received methadone also tended to have less evoked pain at the surgical scar. 23 In a dose escalation study in an ambulatory-surgery population, patients received a single dose of i.v. methadone or a variety of other opioids.…”