Main Regional Center for Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy.
Drugs. 2023 Jul;83(10):865-871. doi: 10.1007/s40265-023-01876-7. Epub 2023 Jun 13.
Intravenous methadone may be useful in acute and chronic pain management compared with other opioids because of its pharmacokinetic and pharmacodynamic characteristics, including the long duration of effect and ability to modulate both pain stimuli propagation and analgesic descending pathways. However, methadone is underused in pain medicine because of several misperceptions. A review of studies was performed to assess data regarding the use of methadone in perioperative pain and chronic cancer pain. The majority of studies have shown that intravenous methadone produces an effective postoperative analgesia and lowers opioid consumption in the postoperative period, without more adverse effects in comparison with other opioid analgesics, and has an interesting potential to prevent persistent postoperative pain. A minority of studies investigated the use of intravenous methadone for cancer pain management. These studies were mostly case series that showed promising activities of intravenous methadone for difficult pain conditions. There is sufficient evidence suggesting that intravenous methadone is effective in perioperative pain, while more studies are needed in patients with cancer pain.
与其他阿片类药物相比，静脉内美沙酮由于其药代动力学和药效学特征，包括作用持续时间长以及能够调节疼痛刺激的传播和镇痛下行途径，在急性和慢性疼痛管理中可能有用。然而，由于存在一些误解，美沙酮在疼痛医学中的应用不足。本文对评估美沙酮在围手术期疼痛和慢性癌痛中应用的数据的研究进行了综述。大多数研究表明，与其他阿片类镇痛药相比，静脉内美沙酮可产生有效的术后镇痛作用，并降低术后期间的阿片类药物消耗，而没有更多的不良反应，并且具有预防持续性术后疼痛的有趣潜力。少数研究调查了静脉内美沙酮用于癌症疼痛管理的情况。这些研究主要是病例系列研究，表明静脉内美沙酮对难治性疼痛具有有前途的作用。有充分的证据表明，静脉内美沙酮在围手术期疼痛中有效，而癌症疼痛患者需要更多的研究。
