Intraoperative methadone for postoperative pain in spine surgery
Nathaniel Cline, BSN, RN
- Sigma Affiliation
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Spine surgery, notorious for causing severe postoperative pain, is often accompanied by elevated rates of opioid usage, necessitating exploration of opioid-sparing approaches to mitigate associated complications. Among these approaches, methadone, a potent mu-receptor agonist with a prolonged half-life of 24-36 hours, has emerged as a promising candidate for reducing postoperative opioid consumption when administered intraoperatively. When given in doses ≥ 20 mg, methadone’s analgesic effect duration mimics its half-life. This case study involves a 52-year-old ASA III female with a history of chronic pain syndrome presenting for posterior fusion of T12-L4 and received methadone 20 mg PO just prior to surgery. The only additional opioid administered intraoperatively was fentanyl 100 mcg. The time to first dose of opioid after arrival to PACU was 8 hours. In total, 60 mg of hydrocodone was the only opioid administered in the first 24-hour postoperative period. No intravenous opioids were given throughout the patient’s 5-day postoperative course. The literature surrounding methadone's utilization in spine surgery is comprehensively reviewed in this case study. In adults undergoing spine surgery, does single-dose intraoperative methadone reduce postoperative opioid consumption compared to other opioids throughout the first 24-hour postoperative period?
|DNP Capstone Project
|None: Degree-based Submission
|Translational Research/Evidence-based Practice
Postoperative Pain Management
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