Department of Anesthesiology, University of California San Francisco, San Francisco, CA.
Nurse Anesthesia Program, School of Nursing, University of Alabama at Birmingham, Birmingham, AL.
J Perianesth Nurs. 2022 Aug;37(4):425-434. doi: 10.1016/j.jopan.2021.08.011. Epub 2022 Apr 6.
Clinically, methadone is most known for its use in the treatment of opioid maintenance therapy. However, methadone's pharmacological profile makes it an excellent analgesic that can enhance acute and chronic pain management. It is a potent μ-receptor agonist with a longer elimination half-life than most clinically used opioids. In addition, methadone inhibits serotonin and norepinephrine uptake, and it is an N-methyl-D-aspartate antagonist. These distinct analgesic pathways mediate hyperalgesic, allodynic, and neuropathic pain. Its unique analgesic properties provide several essential benefits in perioperative use, neuropathic pain, cancer, and noncancer pain. Despite these proven clinical utilities, methadone has not been used widely to treat acute and chronic pain in opioid naïve patients. This article describes the unique pharmacology of methadone and provides emerging evidence to support its application in acute and chronic pain management. Pain management options and guidelines for surgical patients on methadone are discussed as well.
临床上，美沙酮最常用于阿片类药物维持治疗。然而，美沙酮的药理学特性使其成为一种优秀的镇痛药，可增强急性和慢性疼痛管理。它是一种强效μ-受体激动剂，其消除半衰期比大多数临床使用的阿片类药物长。此外，美沙酮抑制血清素和去甲肾上腺素的摄取，并且是 N-甲基-D-天冬氨酸拮抗剂。这些独特的镇痛途径介导痛觉过敏、感觉异常和神经病理性疼痛。其独特的镇痛特性在围手术期使用、神经病理性疼痛、癌症和非癌症疼痛中提供了几个重要的益处。尽管有这些已证实的临床用途，但美沙酮并未广泛用于治疗阿片类药物初治患者的急性和慢性疼痛。本文描述了美沙酮的独特药理学，并提供了新的证据支持其在急性和慢性疼痛管理中的应用。还讨论了接受美沙酮治疗的手术患者的疼痛管理选择和指南。
