We had a journal club where we discussed this article: Anesthesiology, May 2017; Clinical effectiveness and safety of intraoperative methadone in patients undergoing posterior spinal fusion surgery: a randomized, double-blinded, controlled trial.
- IV Methadone 0.2 mg/kg vs IV hydromorphone 2mg at surgical closure in 2+ level spinal fusion
- Decreased postop IV and opioid requirements and pain scores. Improved patient satisfaction
- Is there a pain service following these patients postoperatively?
- Exclusions: do you include OSA and BMI>45 patients?
- Is ETCO2 and PCA enough to combat respiratory depression on the floor?
- Are any discharged on the same day after receiving this dose — think total knees and single level lamis?
- Will this improve or worsen the opioid epidemic?
- Are surgeons on board with tackling pain multimodally for the benefit of the patient?
- For pain follow-up, are there psychiatry, homeopathy, palliative care, PT, holistic approaches for the patient?
Methadone Dose Conversion Guidelines
Sys Rev 2014: Effectiveness of opioid substitution treatments for patients with opioid dependence: a systematic review and multiple treatment protocol.
Am j of Pub Health, Aug 2014. Determinants of Increased Opioid-Related Mortality in the United States and Canada, 1990–2013: A Systematic Review.
Br J Clin Pharmacol. 2014 Feb; 77(2): 272–284. Long term outcomes of pharmacological treatments for opioid dependence: does methadone still lead the pack?
PLoS One. 2014; 9(11): e112328. Methadone Induction in Primary Care for Opioid Dependence: A Pragmatic Randomized Trial (ANRS Methaville).
Curr Psychiatry Rev. 2014 May; 10(2): 156–167. Genetics of Opioid Dependence: A Review of the Genetic Contribution to Opioid Dependence.
Drug Alcohol Depend. 2016 Mar 1; 160: 112–118. Methadone, Buprenorphine and Preferences for Opioid Agonist Treatment: A Qualitative Analysis.
Croat Med J. 2013 Feb; 54(1): 42–48. Risk factors for fatal outcome in patients with opioid dependence treated with methadone in a family medicine setting in Croatia.
J Med Toxicol. 2016 Mar; 12(1): 58–63. Pharmacotherapy of Opioid Addiction: “Putting a Real Face on a False Demon”.
Syst Rev. 2014; 3: 45. Sex differences in outcomes of methadone maintenance treatment for opioid addiction: a systematic review protocol.
Sometimes you need a refresher on measurements of the mitral valve via TEE. Here’s a great 2D TEE walk through for mitral stenosis.
Methods of Determining MVA
Severity of MS