Methadone and Quality of Postoperative Recovery
Endeavor Health
Summary
Patients undergoing cardiac surgery often experience moderate to severe pain in the early postoperative period. A number of methods have been used to help control pain after surgery; however, each of these techniques adds additional costs and risks. A simple and effective way to decrease this pain is to administer a long-acting opioid in the operating room. Methadone is a opioid that can produce analgesia (pain relief) that lasts up to 48 hours when given in large doses (0.3 to 0.4 mg/kg). Previous studies have demonstrated that both pain and requirements for analgesic medications are significantly reduced for up to three days after surgery if methadone is given at induction (the start) of anesthesia. In the study that was performed at Evanston Hospital, cardiac surgical patients who were given methadone also appeared to "feel better" after surgery compared to those given a standard or typical intraoperative opioid. The aim of this randomized clinical trial is to determine whether overall quality of postoperative recovery can be enhanced if methadone is given in the operating room. Quality of recovery will be determined by using a validated scoring system, the QoR 40, which will be given to patients to complete on the first three days after surgery.
Description
Postoperative pain for the adult cardiac surgery patient is complex. Pain can be caused by incisions, intraoperative tissue retraction and dissection, multiple intravascular cannulations, chest tubes left after surgery, and multiple invasive procedures that patients undergo in the operating room and intensive care unit (ICU). Postoperative pain has been described as one of the primary sources of concern for cardiac surgery patients. In this patient population, several studies have demonstrated that pain intensity was moderately severe (approximately 5 on an intensity scale of 10) during the fi…
Eligibility
- Age range
- 18–90 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * All patients presenting for elective cardiac surgery with CPB will be eligible for enrollment Exclusion Criteria: * Preoperative renal failure requiring dialysis or severe renal dysfunction (serum creatinine \> 2.0 mg/dL) * Significant hepatic dysfunction (liver function tests \> 2 times upper normal limit) * Pulmonary disease necessitating home oxygen therapy * Preoperative requirement for inotropic agents or intraaortic balloon pump to maintain hemodynamic stability * Allergy to methadone or fentanyl * Significant preoperative pain requiring treatment with opioids or…
Interventions
- DrugMethadone
Methadone will be provided at induction of anesthesia
- DrugSaline
Saline will be administered at induction of anesthesia
Location
- NorthShore University HealthSystemEvanston, Illinois