Nicolás Arriaza1, Cristian Papuzinski2, Matías Kirmayr3, Marcelo Matta4, Fernando Aranda5, Jana Stojanova6, Eva Madrid7. 1. Department of Anesthesiology and Reanimation, School of Medicine, Universidad de Valparaíso, Valparaíso, Chile; Department of Anesthesiology, Hospital Naval Almirante Nef, Viña del Mar, Chile. ORCID: 0000-0002-1306-237X. 2. Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Valparaíso, Chile; Medical School, Universidad de Valparaíso, Valparaíso, Chile. ORCID: 0000-0002-0080-4506. 3. Medical School, Universidad de Valparaíso, Valparaíso, Chile. ORCID: 0000-0002-3675-3739. 4. Medical School, Universidad de Valparaíso, Valparaíso, Chile. ORCID: 0000-0002-0961-4549. 5. Department of Anesthesiology and Reanimation, School of Medicine, Universidad de Valparaíso, Valparaíso, Chile. ORCID: 0000-0003-3478-5988. 6. Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Valparaíso, Chile. ORCID: 0000-0003-4812-5745. 7. Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Valparaíso, Chile; Medical School, Universidad de Valparaíso, Valparaíso, Chile. Adress: Angamos 655, Reñaca, Viña del Mar, Chile. Email: eva.madrid@uv.cl. ORCID: 0000-0002-8095-5549.
Abstract
BACKGROUND: Postoperative pain management contributes to reducing postoperative morbidity and unscheduled readmission. Compared to other opioids that manage postoperative pain like morphine, few randomized trials have tested the efficacy of intraoperatively administered methadone to provide evidence for its regular use or be included in clinical guidelines. METHODS: We conducted a randomized clinical trial comparing the use of intraoperative methadone to assess its impact on postoperative pain. Eighty-six patients undergoing elective laparoscopic cholecystectomy were allocated to receive either methadone (0.08 mg/kg) or morphine (0.08 mg/kg). RESULTS: Individuals who received methadone required less rescue morphine in the Post Anesthesia Care Unit for postoperative pain than those who received morphine (p = 0.0078). The patients from the methadone group reported less pain at 5 and 15 minutes and 12 and 24 hours following Post Anesthesia Care Unit discharge, exhibiting fewer episodes of nausea. Time to eye-opening was equivalent between the two groups. CONCLUSION: Intraoperative use of methadone resulted in better management of postoperative pain, supporting its use as part of a multimodal pain management strategy for laparoscopic cholecystectomy under remifentanil-based anesthesia.
BACKGROUND: Postoperative pain management contributes to reducing postoperative morbidity and unscheduled readmission. Compared to other opioids that manage postoperative pain like morphine, few randomized trials have tested the efficacy of intraoperatively administered methadone to provide evidence for its regular use or be included in clinical guidelines. METHODS: We conducted a randomized clinical trial comparing the use of intraoperative methadone to assess its impact on postoperative pain. Eighty-six patients undergoing elective laparoscopic cholecystectomy were allocated to receive either methadone (0.08 mg/kg) or morphine (0.08 mg/kg). RESULTS: Individuals who received methadone required less rescue morphine in the Post Anesthesia Care Unit for postoperative pain than those who received morphine (p = 0.0078). The patients from the methadone group reported less pain at 5 and 15 minutes and 12 and 24 hours following Post Anesthesia Care Unit discharge, exhibiting fewer episodes of nausea. Time to eye-opening was equivalent between the two groups. CONCLUSION: Intraoperative use of methadone resulted in better management of postoperative pain, supporting its use as part of a multimodal pain management strategy for laparoscopic cholecystectomy under remifentanil-based anesthesia.