Evanston, IL—Methadone is being repurposed as a way to decrease use of opioids—both intravenous and oral—after surgery.

An article in the journal Anesthesiology discusses what occurred when patients undergoing spinal fusion surgery were treated with methadone during the procedure.

“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,” explained lead author Glenn S. Murphy, MD, physician anesthesiologist at NorthShore University Health System in Evanston, IL. “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.”

Best known as a drug to prevent withdrawal symptoms in opioid-addicted patients, methadone is a unique long-acting opioid commonly used to relieve severe pain in patients who require relief over an extended period of time, as well as those who cannot be treated with other medications, according to background information in the article.

“Appropriate pain control is essential for enhancing recovery,” Murphy pointed out.

“Inadequate postoperative pain relief is associated with the development of a variety of adverse events, including cardiac and pulmonary complications, chronic postsurgical pain, decreased patient satisfaction, and increased morbidity and mortality.”

Acute pain after spinal fusion surgery, which includes herniated disc repair, treatment for narrowing of the spinal canal, and other procedures, is notoriously difficult to manage, the authors suggest. Their study involved 115 patients who either were randomly assigned to receive methadone or who were placed in a control group to receive hydromorphone, a standard opioid painkiller. The drugs were administered during surgery, at the start of surgery, or during surgical closure.

Hydromorphone was also given to the participants following surgery to treat pain, and its use was measured during the first 3 days after surgery to evaluate how effective methadone was in reducing postsurgical pain. Also part of the calculation were patients’ pain scores and satisfaction with pain management during that period.

Results indicate that, in the methadone group, patients required a median of 5 mg of hydromorphone to treat acute pain on the first day after surgery, compared with 10 mg in the control group. On Day 2, meanwhile, patients in the methadone group required less than 1 mg of hydromorphone, compared to 3 mg in the control group. On the third day, patients in the methadone group didn’t require hydromorphone, compared to less than 1 mg in the control group.

Study authors conclude that, overall, patients given methadone required significantly less intravenous and oral opioid medication after surgery, reported lower pain scores, and had improved satisfaction with pain management, compared to patients who were given hydromorphone during surgery.

No differences in opioid-related or other adverse events in either group were found.

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