Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.
Department of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.
Minerva Anestesiol. 2019 Oct;85(10):1053-1061. doi: 10.23736/S0375-9393.19.13136-7. Epub 2019 May 14.
Data from patient questionnaires reveal that the intensity of postoperative pain is widely underestimated. Insufficient pain control may contribute to impaired short- and long-term outcome. Preoperative administration of methadone might potentially improve postoperative pain control due to its long pharmacological half-life.
The aim of this study was to evaluate the effect of a single dose of methadone administered at anesthesia induction on postoperative analgesic requirements in ASA I-III patients after moderate-to-severely painful surgery scheduled for ≥90 minutes. Patients were randomized to receive either a single dose of methadone (0.2 mg/kg) or fentanyl (standard, 0.003 mg/kg) intravenously (IV) at anesthesia induction. For postoperative pain control, all study patients were accommodated with morphine on the basis of patient-controlled analgesia (PCA).
Per-protocol analysis revealed that the median cumulative morphine consumption was significantly lower in patients receiving a single dose of methadone, in the Postanesthesia Care Unit (0 mg vs. 7 mg of morphine, P<0.01) and during the first 72 hours after surgery (19 mg vs. 35 mg of morphine, P<0.05 for all days). Fentanyl consumption during surgery (0.25 mg [0.1-0.425 mg] in the study group vs. 0.3 mg [0.15-0.45 mg] in the control group, P=0.4499) was comparable among groups. Median pain scores at rest and in motion, and patient satisfaction were also similar in both groups (95.7% vs. 89.3% of patients were satisfied in the study and control group, respectively) during follow-up on postoperative days 1-3.
A single dose of methadone administered at anesthesia induction prior to moderate-to-severely painful surgery is a possible strategy to reduce postoperative morphine consumption.
患者问卷调查数据显示，术后疼痛强度普遍被低估。疼痛控制不足可能会导致短期和长期预后受损。术前给予美沙酮可能会通过其较长的药理学半衰期来改善术后疼痛控制。
本研究旨在评估麻醉诱导时单次给予美沙酮对接受中重度疼痛手术（预计持续时间≥90 分钟）的 ASA I-III 患者术后镇痛需求的影响。患者被随机分为接受单次剂量美沙酮（0.2mg/kg）或芬太尼（标准剂量，0.003mg/kg）静脉注射。所有研究患者均采用基于患者自控镇痛（PCA）的吗啡进行术后镇痛。
意向性治疗分析显示，接受单次剂量美沙酮的患者术后在麻醉后恢复室（0mg 与 7mg 吗啡，P<0.01）和术后 72 小时内（19mg 与 35mg 吗啡，P<0.05，所有天数）的累积吗啡消耗量中位数显著降低。手术期间芬太尼消耗量（研究组 0.25mg[0.1-0.425mg]与对照组 0.3mg[0.15-0.45mg]，P=0.4499）在两组间无差异。在术后第 1-3 天的随访中，两组患者的静息和运动时的中位数疼痛评分以及患者满意度也相似（研究组和对照组分别有 95.7%和 89.3%的患者满意）。
在接受中重度疼痛手术前，麻醉诱导时单次给予美沙酮可能是减少术后吗啡消耗的一种策略。
