Department of Anesthesiology & Perioperative Medicine, MD Anderson Cancer Center, Houston, TX, United States of America; Department of Biostatistics, MD Anderson Cancer Center, Houston, TX, United States of America; Anesthesiology and Surgical Oncology Research Group, Houston, TX, United States of America.
Department of Anesthesiology & Perioperative Medicine, MD Anderson Cancer Center, Houston, TX, United States of America.
J Clin Anesth. 2024 Nov;98:111572. doi: 10.1016/j.jclinane.2024.111572. Epub 2024 Aug 23.
Breast cancer is the most frequent type of cancer and the second leading cause of cancer-related mortality in women. Mastectomies remain a key component of the treatment of non-metastatic breast cancer, and strategies to treat acute postoperative pain, a complication affecting nearly all patients undergoing surgery, continues to be an important clinical challenge. This study aimed to determine the impact of intraoperative methadone administration compared to conventional short-acting opioids on pain-related perioperative outcomes in women undergoing a mastectomy.
This single-center retrospective study included adult women undergoing total mastectomy. The primary outcome of this study was postoperative pain intensity on day 1 after surgery. Secondary outcomes included perioperative opioid consumption, perioperative non-opioid analgesics use, duration of surgery and anesthesia, time to extubation, pain intensity in the postanesthesia care unit (PACU), anti-emetic use in PACU, and length of stay in hospital. We used the propensity score-based nearest matching with a 1:3 ratio to balance the patient baseline characteristics.
133 patients received methadone, and 2192 patients were treated with short-acting opioids. The analysis demonstrated that methadone was associated with significantly lower intraoperative and postoperative opioid consumption as measured by oral morphine equivalents and lower average pain intensity scores in the postanesthesia care unit. Moreover, methadone was also shown to reduce the use of non-opioid analgesia during surgery.
Our study suggests that the unique pharmacological properties of methadone, including a short onset of action when given intravenously, long-acting pharmacokinetics, and multimodal effects, are associated with better acute pain management after a total mastectomy.
乳腺癌是最常见的癌症类型，也是女性癌症相关死亡的第二大主要原因。乳房切除术仍然是治疗非转移性乳腺癌的关键组成部分，而治疗急性术后疼痛的策略，这种并发症几乎影响所有接受手术的患者，仍然是一个重要的临床挑战。本研究旨在确定与常规短效阿片类药物相比，术中给予美沙酮对接受乳房切除术的女性围手术期疼痛相关结局的影响。
这是一项单中心回顾性研究，纳入了接受全乳房切除术的成年女性。本研究的主要结局是手术后第 1 天的术后疼痛强度。次要结局包括围手术期阿片类药物消耗、围手术期非阿片类镇痛药使用、手术和麻醉持续时间、拔管时间、麻醉后护理单元（PACU）中的疼痛强度、PACU 中的止吐药使用和住院时间。我们使用基于倾向评分的最近匹配，比例为 1:3，以平衡患者的基线特征。
133 名患者接受了美沙酮，2192 名患者接受了短效阿片类药物治疗。分析表明，美沙酮与术中及术后阿片类药物消耗显著减少相关，以口服吗啡等效物衡量，并在 PACU 中具有较低的平均疼痛强度评分。此外，美沙酮还可减少手术期间非阿片类镇痛药的使用。
我们的研究表明，美沙酮的独特药理学特性，包括静脉给予时起效迅速、作用持久的药代动力学特性以及多模式作用，与全乳房切除术后急性疼痛管理的改善有关。
