World Journal of Colorectal Surgery (Oct 2023)
Intraoperative Methadone Use in Patients Undergoing Minimally Invasive Colorectal Surgical Procedures
Abstract
Background: Postoperative pain control is an important aspect in the recovery of patients. Recent literature suggests that the extended half-life of methadone may reduce overall opioid utilization in postoperative patients. However, there have yet to be any studies examining the efficacy of methadone as part of the protocol for enhanced recovery after colorectal surgery in patients. Objectives: To review the efficacy of perioperative methadone in reducing postoperative opioid usage and patient pain control. Design: Retrospective observational study. Settings: Tertiary academic center. Patients and Methods: Eighty-nine patients were identified from a prospectively maintained database having received methadone perioperatively from 2019 to 2021. These were compared to 89 historical controls identified from the same database and matched on procedure type, age, and American Society of Anesthesiology status. Main Outcome Measures: Primary outcomes were postoperative opioid use and subjective pain scores. Secondary outcomes were length of hospital stay, return of bowel function, and hospital cost. Sample Size: 89 patients receiving methadone and 89 historical control patients. Conclusions: The patients who received methadone used significantly more opioids overall compared to non-methadone patients (P = 0.015). In addition, there was no significant difference in pain scores for methadone vs non-methadone patients (P = 0.630). Furthermore, there was no difference in the length of stay and return of bowel function (P = 0.512 and P = 0.140, respectively). Moreover, opioid-naïve patients, regardless of methadone status, showed reduced average pain compared to non-naïve patients (P = 0.010 and P = 0.010, respectively). Despite support in surgical literature, we failed to find clinical benefit in including methadone as a part of the enhanced recovery pathway for patients undergoing minimally invasive colorectal surgery. Limitations: Retrospective design limited to minimally invasive techniques. Conflicts of interest The authors have no conflicts of interest to declare.
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