The role of methadone in cardiac surgery for management of postoperative pain
Jordan N. Edwards,
Madeline A. Whitney,
Bradford B. Smith,
Megan K. Fah,
Skye A. Buckner Petty,
Omar Durra,
Kristen A. Sell-Dottin,
Erica Portner,
Erica D. Wittwer,
Adam J. Milam
Affiliations
Jordan N. Edwards
Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
Madeline A. Whitney
Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
Bradford B. Smith
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
Megan K. Fah
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
Skye A. Buckner Petty
Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ, USA
Omar Durra
Keck School of Medicine of USC, Los Angeles, CA, USA
Kristen A. Sell-Dottin
Department of Cardiovascular Surgery, Mayo Clinic, Phoenix, AZ, USA
Erica Portner
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
Erica D. Wittwer
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
Adam J. Milam
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA; Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ, USA; Corresponding author. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA.
Background: This retrospective study evaluated the efficacy and safety of intraoperative methadone compared with short-acting opioids. Methods: Patients undergoing cardiac surgery with cardiopulmonary bypass (n=11 967) from 2018 to 2023 from a single health system were categorised into groups based on intraoperative opioid administration: no methadone (Group O), methadone plus other opioids (Group M+O), and methadone only (Group M). Results: Patients in Groups M and M+O had lower mean pain scores until postoperative day (POD) 7 compared with Group O after adjusting for covariates (P<0.01). Both Groups M and M+O had lower total opioid administered compared with Group O for all days POD0–POD6 (all P<0.001). The median number of hours until initial postoperative opioid after surgery was 2.55 (inter-quartile range [IQR]=1.07–5.12), 6.82 (IQR=3.52–12.98), and 7.0 (IQR=3.82–12.95) for Group O, Group M+O, and Group M, respectively. The incidence of postoperative complications did not differ between groups. Conclusions: Intraoperative administration of methadone was associated with better pain control without significant side-effects after cardiac surgery.
