The role of methadone in cardiac surgery for management of postoperative pain
J Edwards, Madeline Whitney, Bradford B. Smith, Megan K. Fah, Skye A. Buckner Petty, Omar Durra, Kristen Sell‐Dottin, Erica Portner, Erica D. Wittwer, Adam J. Milam
Abstract
Background This retrospective study evaluated the efficacy and safety of intraoperative methadone compared with short-acting opioids. Methods Patients undergoing cardiac surgery with cardiopulmonary bypass ( n =11 967) from 2018 to 2023 from a single health system were categorised into groups based on intraoperative opioid administration: no methadone (Group O), methadone plus other opioids (Group M+O), and methadone only (Group M). Results Patients in Groups M and M+O had lower mean pain scores until postoperative day (POD) 7 compared with Group O after adjusting for covariates ( P <0.01). Both Groups M and M+O had lower total opioid administered compared with Group O for all days POD0–POD6 (all P <0.001). The median number of hours until initial postoperative opioid after surgery was 2.55 (inter-quartile range [IQR]=1.07–5.12), 6.82 (IQR=3.52–12.98), and 7.0 (IQR=3.82–12.95) for Group O, Group M+O, and Group M, respectively. The incidence of postoperative complications did not differ between groups. Conclusions Intraoperative administration of methadone was associated with better pain control without significant side-effects after cardiac surgery.