Originally presented by Dr Jason Sritharan
Background
- Methadone is a drug with unique pharmacokinetics and dynamics
- It is increasingly being used for analgesia in the intraoperative setting
- Many anaesthetists are unfamiliar with its dosing regimen so tend to use more familiar opioids
Unique advantages
- Potent mu opioid receptor agonist
- Longest half-life of clinically used opioids
- NMDA receptor antagonist
- Serotonin re-uptake inhibition
- Noradrenaline re-uptake inhibition
Evidence
Summary of findings:
- Intraoperative use of methadone reduced post operative opioid consumption when compared with the use of other opioids intraoperatively
- Methadone dosing regimens varied between trials. Average dose 0.1-0.2mg/kg
- There was no statistically significant difference in respiratory complications amongst the studies reviewed
Links
Clinical Effectiveness and Safety of Intraoperative Methadone, 2017.