Abstract
Methods We performed a quantitative systematic review of randomized controlled trials in PubMed, Embase, Cochrane Library, and Google Scholar electronic databases. Meta-analysis was performed using the random effects model, weighted mean differences (WMD), standard deviation, 95% confidence intervals, and sample size. Methodological quality was evaluated using Cochrane Collaboration's tool. Results Seven randomized controlled trials evaluating 337 patients across different surgical procedures were included. The aggregated effect of intraoperative methadone on postoperative opioid consumption did not reveal a significant effect, WMD (95% CI) of −0.51 (−1.79 to 0.76), (P=0.43) IV morphine equivalents. In contrast, the effect of methadone on postoperative pain demonstrated a significant effect in the postanesthesia care unit, WMD (95% CI) of −1.11 (−1.88 to −0.33), P=0.005, and at 24 hours, WMD (95% CI) of −1.35 (−2.03 to −0.67), P < 0.001. Conclusions The use of intraoperative methadone reduces postoperative pain when compared to morphine. In addition, the beneficial effect of methadone on postoperative pain is not attributable to an increase in postsurgical opioid consumption. Our results suggest that intraoperative methadone may be a viable strategy to reduce acute pain in surgical patients.
Highlights
Opioid analgesics is still the primary treatment for moderate-to-severe postsurgical pain despite new therapies and interventions [1,2,3]
Several randomized studies have compared the use of intraoperative methadone to morphine regarding postsurgical analgesia, but they have generated conflicting results
A comprehensive search of randomized trials investigating intraoperative methadone to morphine on postoperative surgical analgesia was performed using electronic databases PubMed database, Google Scholar, the Cochrane Database of Systematic Reviews, and Embase from inception up to January 2019. e search words “methadone,” “intraoperative methadone,” “postsurgical, “postoperative,” and “pain” were used in various combinations using Boolean operators
Summary
Opioid analgesics is still the primary treatment for moderate-to-severe postsurgical pain despite new therapies and interventions [1,2,3]. Used opioids (e.g., morphine) have short duration of action (up to 5 hours) and require frequent dosing to maintain adequate postoperative analgesia [9, 10]. Methadone has a much longer duration of action (up to 36 hours) that may lead to better postsurgical pain control [11]. Several randomized studies have compared the use of intraoperative methadone to morphine regarding postsurgical analgesia, but they have generated conflicting results. It is currently unknown if the use of intraoperative methadone can lead to better postsurgical pain when compared to intraoperative morphine. E main objective of the current investigation is to compare the analgesic efficacy of intraoperative methadone to intraoperative morphine for postoperative analgesia. We sought to examine potential side effects related to the use of intraoperative methadone
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