Methadone is safe for treating hospitalized patients with severe pain

Abstract

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

Efeitos da metadona ou do neostigmine, associados à lidocaína administrados pela via epidural em cães

“…A analgesia pós-operatória após administração da metadona por essa via foi considerada satisfatória após diversos procedimentos cirúrgicos, tais como toracotomia (Parramon et al, 2003), laparotomia (Prieto-Alvarez et al, 1997) e cirurgia corretiva de hérnia de disco lombar (Hernandez-Palazon et al, 1997). A incidência de efeitos adversos após a administração epidural de metadona foi baixa e consistiu em depressão respiratória (PrietoAlvarez et al, 1997;Shir et al, 2001), náuseas e prurido (Haynes et al, 1993), sendo a incidência de alguns desses efeitos mais baixa quando comparada à de outros opióides (morfina e fentanil) pela mesma via (Gedney e Liu, 1998).…”

Review article: Perioperative pain management of patients on methadone therapy

“…7 There are reports of methadone being used for its analgesic properties by continuous epidural administration in children as well as adults. 8,9 Intrathecal analgesic use has also been reported. 10,11 Methadone, a lipophilic basic drug (pKa 9.2), exists as a racemic mixture of two enantiomers, R-methadone (R-Met or l-isomer) and S-methadone (S-Met or d-isomer).…”

Factors associated with illicit methadone injecting in a Canadian setting

“…Methadone is also used for the treatment of cancer pain and chronic non-cancer pain in a variety of settings [5][6][7]. However, the risk of sedation and respiratory depression with improper methadone dosing remains.…”