Christian Rajkovic, Sima Vazquez, Zach Thomas, Eris Spirollari, Bridget Nolan, Cameron Marshall, Nitin Sekhri, Ammar Siddiqui, Merritt D Kinon, John V Wainwright
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Methadone presents an alternative to pure mu opioids which may improve postoperative management of pain following intraoperative use.</p><p><strong>Methods: </strong>A systematic review of MEDLINE, Embase, and Web of Science databases was conducted to review existing literature detailing operating time, postoperative pain, opioid usage, and hospital length of stay (LOS) following intraoperative methadone administration in spine surgery.</p><p><strong>Results: </strong>Following screening of 994 articles and application of inclusion criteria, 8 articles were included, 4 of which were retrospective. Conventional spine surgery intraoperative analgesic strategies used as comparators for intraoperative methadone included hydromorphone, ketamine, and sufentanil. Considering patient outcomes, included studies observed that patients treated with intraoperative methadone had statistically similar or significantly reduced pain scores, opioid usage, and LOS compared with comparator analgesics. 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引用次数: 0
摘要
研究设计系统综述：系统回顾脊柱手术术中美沙酮的使用情况，研究其对术后阿片类药物使用、疼痛、住院时间和手术时间的影响：脊柱手术患者通常都有慢性疼痛和阿片类药物使用史，因此术后剧烈疼痛的风险也随之增加。虽然纯阿片类药物仍是急性手术疼痛治疗的标准药物，但它们会带来严重的短期和长期不良反应。美沙酮是纯阿片类药物的替代品，可改善术中使用后的术后疼痛管理：方法：对 MEDLINE、Embase 和 Web of Science 数据库进行了系统性回顾，回顾了脊柱手术术中使用美沙酮后的手术时间、术后疼痛、阿片类药物使用和住院时间（LOS）等方面的现有文献：结果：在对994篇文章进行筛选并应用纳入标准后，共纳入8篇文章，其中4篇为回顾性文章。作为术中美沙酮的比较对象，传统脊柱手术术中镇痛策略包括氢吗啡酮、氯胺酮和舒芬太尼。考虑到患者的治疗效果，纳入的研究发现，术中美沙酮治疗患者的疼痛评分、阿片类药物用量和住院时间与对比镇痛药相比，在统计学上相似或显著减少。不过，一项研究观察到，与单独使用术中美沙酮相比，术中美沙酮与氯胺酮一起用于多模式镇痛方案策略可缩短患者的生命周期。在纳入的研究中，术中使用美沙酮的病例与使用对比镇痛药的病例在手术时间上的差异没有统计学意义：结论：美沙酮可作为脊柱手术恢复方案中术中和术后镇痛的替代选择，可减少术后疼痛、阿片类药物的使用和手术时间，同时保持手术时间的一致性并减少纯阿片类药物的副作用：证据等级：二级。
Intraoperative Methadone in Spine Surgery ERAS Protocols: A Systematic Review of the Literature.
Study design: Systematic review.
Objective: To systematically review the use of intraoperative methadone in spine surgery and examine its effects on postoperative opioid use, pain, length of stay, and operative time.
Summary of background data: Spine surgery patients commonly have a history of chronic pain and opioid use, and as a result, they are at an increased risk of severe postoperative pain. While pure mu opioids remain the standard for acute surgical pain management, they are associated with significant short-term and long-term adverse events. Methadone presents an alternative to pure mu opioids which may improve postoperative management of pain following intraoperative use.
Methods: A systematic review of MEDLINE, Embase, and Web of Science databases was conducted to review existing literature detailing operating time, postoperative pain, opioid usage, and hospital length of stay (LOS) following intraoperative methadone administration in spine surgery.
Results: Following screening of 994 articles and application of inclusion criteria, 8 articles were included, 4 of which were retrospective. Conventional spine surgery intraoperative analgesic strategies used as comparators for intraoperative methadone included hydromorphone, ketamine, and sufentanil. Considering patient outcomes, included studies observed that patients treated with intraoperative methadone had statistically similar or significantly reduced pain scores, opioid usage, and LOS compared with comparator analgesics. However, one study observed that intraoperative methadone used in a multimodal analgesia regimen strategy with ketamine resulted in a shortened LOS compared with the use of intraoperative methadone alone. Differences in operating time between cases that used intraoperative methadone and cases that used comparator analgesics were not statistically significant among included studies.
Conclusion: Methadone may present an alternative option for both intraoperative and postoperative analgesia in spine surgery recovery protocols and may reduce postoperative pain, opioid use, and LOS while maintaining consistent operating time and reduced side effects of pure mu opioids.
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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