Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, United States of America.
Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, United States of America.
PLoS One. 2023 Jul 21;18(7):e0288988. doi: 10.1371/journal.pone.0288988. eCollection 2023.
To compare efficacy of oral versus intravenous (IV) methadone on postoperative pain and opioid requirements after spine surgery.
This was a retrospective, single-academic center cohort study evaluating 1010 patients who underwent >3 level spine surgery from January 2017 to May 2020 and received a one-time dose of oral or intravenous methadone prior to surgery. The primary outcome measured was postoperative opioid use in oral morphine equivalents (ME) and verbal response scale (VRS) pain scores up to postoperative day (POD) three. Secondary outcomes were time to first bowel movement and adverse effects (reintubation, myocardial infarction, and QTc prolongation) up to POD 3.
A total of 687 patients received oral and 317 received IV methadone, six patients were excluded. The IV group received a significantly greater methadone morphine equivalent (ME) dose preoperatively (112.4 ± 83.0 mg ME versus 59.3 ± 60.9 mg ME, p < 0.001) and greater total (methadone and non-methadone) opioid dose (119.1 ± 81.4 mg ME versus 63.9 ± 62.5 mg ME, p < 0.001), intraoperatively. Although pain scores for the oral group were non-inferior to the IV group for all postoperative days (POD), non-inferiority for postoperative opioid requirements was demonstrated only on POD 3. Based on the joint hypothesis for the co-primary outcomes, oral methadone was non-inferior to IV methadone on POD 3 only. No differences in secondary outcomes, including QTc prolongation and arrhythmias, were noted between the groups.
Oral methadone is a feasible alternative to IV methadone for patients undergoing spine surgery regarding both pain scores and postoperative opioid consumption.
比较口服与静脉（IV）美沙酮在脊柱手术后的术后疼痛和阿片类药物需求方面的疗效。
这是一项回顾性、单中心队列研究，评估了 2017 年 1 月至 2020 年 5 月间接受>3 级脊柱手术并在手术前接受单次口服或静脉美沙酮的 1010 例患者。主要观察指标为术后口服吗啡等效物（ME）和口头反应量表（VRS）疼痛评分至术后第 3 天（POD）的阿片类药物使用量。次要结局为首次排便时间和不良反应（重新插管、心肌梗死和 QTc 延长）至 POD3。
共 687 例患者接受口服美沙酮，317 例患者接受 IV 美沙酮，6 例患者被排除。IV 组术前接受的美沙酮吗啡等效剂量（112.4±83.0mg ME 与 59.3±60.9mg ME，p<0.001）和总（美沙酮和非美沙酮）阿片类药物剂量（119.1±81.4mg ME 与 63.9±62.5mg ME，p<0.001）均显著更高。虽然口服组在所有术后日的疼痛评分均不劣于 IV 组，但仅在 POD3 时显示术后阿片类药物需求的非劣效性。根据联合主要结局的假设，口服美沙酮仅在 POD3 时不劣于 IV 美沙酮。两组间的次要结局，包括 QTc 延长和心律失常，无差异。
对于接受脊柱手术的患者，口服美沙酮在疼痛评分和术后阿片类药物消耗方面可作为 IV 美沙酮的可行替代方案。
