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Intraoperative use of methadone improves control of postoperative pain in morbidly obese patients: a randomized controlled study

Authors Machado FC, Palmeira CCA, Torres JNL, Vieira JE, Ashmawi HA

Received 25 April 2018

Accepted for publication 24 July 2018

Published 2 October 2018 Volume 2018:11 Pages 2123—2129

DOI https://doi.org/10.2147/JPR.S172235

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Justinn Cochran

Peer reviewer comments 2

Editor who approved publication: Dr Katherine Hanlon


Felipe Chiodini Machado, Claudia Carneiro de Araújo Palmeira, João Nathanael Lima Torres, Joaquim Edson Vieira, Hazem Adel Ashmawi

Anesthesiology Department, hcFMUsP, Universidade de São Paulo, São Paulo, Brazil

Objectives: Surgical patients still commonly experience postoperative pain. With the increasing prevalence of obesity, there is a growing demand for surgical procedures by this population. Intraoperative use of methadone has not been well assessed in this population.
Materials and methods: Patients with a body mass index of 35  kg/m2 or more undergoing bariatric surgery were randomly assigned to receive either fentanyl (group F) or methadone (group M) in anesthesia induction and maintenance. The primary outcome was morphine consumption during the first 24 hours after surgery through a patient-controlled analgesia device. Secondary outcomes were pain scores at rest and while coughing, opioid related side effects, and patient satisfaction. The patients were also evaluated 3 months after surgery for the presence of pain, dysesthesia, or paresthesia at surgical site.
Results: Postoperative morphine consumption was significantly higher for patients receiving fentanyl than methadone during the postoperative period at 2 hours (mean difference [MD] 6.4 mg; 95% CI 3.1–9.6; P<0.001), 2–6 hours (MD 11.4 mg; 95% CI 6.5–16.2; P<0.001), 6–24 hours (MD 10.4 mg; 95% CI 5.0–15.7; P<0.001), and 24–48 hours (MD 14.5 mg; 95% CI 3.9–25.1; P=0.01). Patients from group F had higher pain scores until 24 hours postoperatively, higher incidence of nausea and vomiting, lower satisfaction, and more evoked pain at surgical scar at the 3-month postoperative evaluation than group M.
Conclusion: Intraoperative methadone can safely lower postoperative opioid consumption and improve postoperative pain scores compared with fentanyl in morbidly obese patients.

Keywords: postoperative pain, bariatric surgery, acute pain, postoperative pain, methadone

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