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Intraoperative Methadone Is Associated with Decreased Perioperative Opioid Use Without Adverse Events: A Case-Matched Cohort Study

Published:November 04, 2019DOI:https://doi.org/10.1053/j.jvca.2019.09.033

      Objective

      To determine if there is an association of intraoperative methadone use and total perioperative opioid exposure in patients undergoing congenital heart surgeries.

      Design

      Retrospective, case-match cohort study.

      Setting

      Single center quaternary care teaching hospital.

      Participants

      Seventy-four patients with congenital heart disease (CHD) undergoing surgical repair or palliative surgery.

      Intervention

      Thirty-seven patients undergoing CHD surgeries receiving intraoperative methadone were matched to 37 patients based upon age and procedure who did not receive intraoperative methadone. The primary study outcome was to evaluate total opioid use in intravenous milligrams of morphine equivalents per kilogram (mg ME/kg) within the first 36-hours postoperatively. Mann-Whitney U test was used to compare total opioid exposure.

      Measurements and Main Results

      The total opioid use was compared between groups. The methadone cohort required less opioids intraoperatively, in the first 12 hours postoperatively, and during the first 36 hours postoperatively (2.51 v 4.39 mg ME/kg, p < 0.001; 0.43 v 1.28 mg ME/kg, p = 0.001; and 0.83 v 1.91 mg ME/kg, p < 0.001) compared with the matched control cohort. There were no differences in clinical outcomes or adverse events. A dose-dependent reduction in opioid consumption in high- versus low-dose groups also was not observed.

      Conclusion

      Intraoperative methadone use was associated with a decrease in perioperative opioid exposure in patients undergoing congenital heart surgery and was not associated with adverse events or prolonged durations of mechanical ventilation or ICU stay.

      Key Words

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      Linked Article

      • Is Methadone an Opioid Sparing Strategy?
        Journal of Cardiothoracic and Vascular AnesthesiaVol. 34Issue 2
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          IN THIS ISSUE OF THE Journal of Cardiothoracic and Vascular Anesthesia, Robinson et al. sought to determine whether intraoperative methadone administration decreases acute perioperative opioid use in children undergoing congenital heart surgery.1 This is a particularly important question in an era in which the opioid epidemic has emerged as a forefront issue, emphasizing the importance of improving the quality of healthcare such that it is safer and more effective. While adult perioperative opioid prescribing patterns have been well recognized as contributory to this crisis, the pediatric surgical population is also vulnerable.
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