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
Intraop Lidocaine for postop pain
Intraop Ketamine for postop pain
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