Intraoperative Utilization of Intravenous Methadone for Postoperative Pain Control.

Purpose: Postoperative pain is a unique experience that can be challenging to manage. It is imperative that perioperative nursing staff have a sound understanding of a multitude of pharmacological interventions. When compared to other intraoperative opioids, intravenous methadone has not been widely researched as a tool for the prevention of postoperative pain. The purpose of this systematic review is to provide evidence for its use and efficacy in preventing postoperative pain.

Design: Systematic review.

Methods: This review used a broad research strategy to seek out relevant publications from the last decade (2014 to January 2024). The databases used included MEDLINE (PubMed) and Google Scholar. Out of the initial 129 studies identified, 7 relevant clinical trials, 2 retrospective reviews, and 1 systematic review were chosen based on the inclusion criteria.

Findings: Patients who received adequate doses of intraoperative methadone, defined as doses between 0.1 and 0.4 mg/kg ideal body weight had lower pain scores and decreased opioid consumption in the PACU compared to patients who received shorter-acting opioids in the intraoperative phase. Studies demonstrated that methadone use did not increase time to extubation at the end of surgery and was not associated with significant respiratory complications during recovery.

Conclusions: This review supports that incorporating intravenous methadone can yield a satisfactory analgesic profile for a wide array of surgeries, including ambulatory surgery, cardiac surgery, and intra-abdominal surgery. More clinical trials are needed to determine specific dosing guidelines and to vet the safety and efficacy in patients with various comorbidities.