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Opioid Use Drops, Pain Management Improves with Intraoperative Methadone

News  |  By Jennifer Thew RN  
   May 04, 2017

Patients treated with methadone during spinal fusion surgery required less hydromorphone and reported improved satisfaction with pain management.

Patients who received intraoperative methadone during spinal fusion surgery required less postoperative opioid pain medication and reported decreased pain scores and improved satisfaction with pain management, finds a study published in the May issue Anesthesiology.

For the study, 115 patients were randomly assigned to one of two groups. One group received methadone at the start of surgery while the control group received hydromorphone during surgical closure. Hydromorphone was also given to both groups to treat postoperative pain.

To gauge methadone’s effectiveness in reducing postsurgical pain, researchers measured how much hydromorphone patients took during the first three days after surgery. Patients’ pain scores and satisfaction with pain management were also measured during that time.

Patients who received methadone required less hydromorphone than the control group (a median of 5 mg vs 10 mg) on the first day after surgery. On postop day two, patients in the methadone group required less than 1 mg of hydromorphone while the control group required 3 mg. By day three, patients in the methadone group no longer required hydromorphone while the control group required less than 1 mg.  

In addition to less postoperative opioid medication, patients receiving methadone reported lower pain scores at rest, with movement, and with coughing than the control group. The intervention group also reported higher satisfaction with pain management than those receiving hydromorphone alone.

 “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,” Glenn S. Murphy, MD, lead study author and physician anesthesiologist at NorthShore University Health System in Evanston, Illinois, said in a media statement.

“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.”

Indeed, data on the prevalence and cost of prescription opioid abuse is alarming. According to the CDC, the rate of overdose deaths involving opioids (prescription opioid pain relievers and heroin) has quadrupled since 1999, and over 165,000 people have died from prescription opioid overdoses. The agency estimates that prescription opioid abuse results in over $72 billion in medical costs each year.

To help combat prescription opioid abuse, the CDC issued guidelines for prescribing opioids for chronic pain in March. 

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.


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