Methadone May Reduce Post-Surgical Opioid Use

In the past, patients undergoing invasive surgery have typically received prescription opioids to manage pain. Due to an increase in opioid misuse, prescribers have had to devise an alternate approach to pain management for many patients. Researchers have also taken on the task of exploring the efficacy of novel approaches.

Findings from a new study published by Anesthesiology suggest that treating patients undergoing a spinal fusion surgery with methadone during the procedure may require less opioids to manage post-operative pain. This could significantly improve pain management, while lessening the risk of opioid misuse among patients.

"This is a new application for an old pain medication that offers hope for reducing the development of acute pain in the first few days after surgery, as well as chronic postoperative pain and the need for opioid medications following discharge from the hospital," said lead study author Glenn S. Murphy, MD. "There is currently an opioid crisis in the United States, and intraoperative methadone offers promise as a drug that can reduce the need for these pain medications during recovery."

Methadone is a long-acting opioid that is generally used to treat patients with severe pain. Patients treated with methadone typically need to be on therapy for long periods of time and cannot be treated with other drugs. Additionally, methadone has been used to prevent withdrawal symptoms among patients with opioid misuse disorder.

"Appropriate pain control is essential for enhancing recovery," Dr Murphy said. "Inadequate postoperative pain relief is associated with the development of a variety of adverse events, including cardiac and pulmonary complications, chronic postsurgical pain, decreased patient satisfaction, and increased morbidity and mortality."

Severe pain after surgery remains a common and undertreated problem. Although there have been significant advances in pain management, patients may experience severe pain during the first 3 days post-surgery.

Acute pain after spinal fusion surgery, in particular, may be difficult to manage. The study authors reported that these patients often have chronic nerve pain and are dependent on opioids.

Included in the study were 115 patients randomized to receive methadone or hydromorphone (control group) at the beginning of the procedure or during surgical closure, respectively, according to the study. Hydromorphone is a standard opioid that is commonly used to manage post-operative pain. All patients were treated with hydromorphone after surgery.

The authors determined how much hydromorphone patients received within 3 days of surgery and also looked at pain scores and pain management satisfaction during that time.

In the methadone group, patients required treatment with a median of 5-mg of hydromorphone during the first 3 days after surgery, while the control group required 10-mg, according to the study.

On day 2, the authors discovered that patients in the methadone group required less than 1-mg of hydromorphone, compared with 3-mg for patients in the control group. After 3 days, hydromorphone was discontinued in the methadone group, while the control group required less than 1-mg of the drug.

Overall, the authors noted that patients treated with methadone required significantly less opioids post-surgery. These patients also reported lower pain scores and had improved satisfaction with pain management compared with control patients.

Importantly, there were no differences in opioid-related or adverse events in either group, meaning that methadone may present a safer treatment option, the study concluded.