Clinical effectiveness and safety of intraoperative methadone in patients undergoing laparoscopic hysterectomy: a randomised, blinded clinical trial
Background: Laparoscopic hysterectomy is often carried out as day-stay surgery. Minimising postoperative pain is therefore of utmost importance to ensure timely discharge from hospital. Methadone has several desirable pharmacological features, including a long elimination half-life. Therefore, a sin...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | BJA Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772609623000989 |
| _version_ | 1797677706734731264 |
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| author | Kristian D. Friesgaard Lone D. Brix Christina B. Kristensen Omar Rian Lone Nikolajsen |
| author_facet | Kristian D. Friesgaard Lone D. Brix Christina B. Kristensen Omar Rian Lone Nikolajsen |
| author_sort | Kristian D. Friesgaard |
| collection | DOAJ |
| description | Background: Laparoscopic hysterectomy is often carried out as day-stay surgery. Minimising postoperative pain is therefore of utmost importance to ensure timely discharge from hospital. Methadone has several desirable pharmacological features, including a long elimination half-life. Therefore, a single intraoperative dose could provide long-lasting pain relief. Methods: Patients scheduled to undergo laparoscopic hysterectomy were randomly allocated to receive methadone (0.2 mg kg−1) or morphine (0.2 mg kg−1) intraoperatively, 60 min before tracheal extubation. Primary outcomes were opioid consumption (oral morphine equivalents in milligrams) at 6 and 24 h. Secondary outcomes included pain intensity at rest and during coughing, patient satisfaction, postoperative nausea and vomiting, and adverse events up to 72 h after completion of surgery. Results: The postoperative median opioid consumption was reduced in the methadone group compared with the morphine group at 6 h (35.5 [0–61] mg vs 48 [31–74.5] mg; P=0.01) and 24 h (42 [10–67] mg vs 54.5 [31–83] mg; P=0.03). On arrival at the PACU, pain at rest was significantly lower in patients receiving methadone (numeric rating scale: 3 [2–5] vs 5 [3–6]), whereas pain scores at rest and coughing were not significantly different throughout the rest of the observation period. No differences in other secondary outcomes were found. Conclusions: In this randomised, blinded, controlled trial, opioid consumption was reduced during the first 24 postoperative hours in patients receiving methadone without causing an increase in adverse events. The difference observed might be considered as small and of limited clinical relevance. Clinical trial registration: NCT03908060; EudraCT no. 2018-004351-20. |
| first_indexed | 2024-03-11T22:48:09Z |
| format | Article |
| id | doaj.art-c732f93e070e4601acc5713499e398be |
| institution | Directory Open Access Journal |
| issn | 2772-6096 |
| language | English |
| last_indexed | 2024-03-11T22:48:09Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | BJA Open |
| spelling | doaj.art-c732f93e070e4601acc5713499e398be2023-09-22T04:40:17ZengElsevierBJA Open2772-60962023-09-017100219Clinical effectiveness and safety of intraoperative methadone in patients undergoing laparoscopic hysterectomy: a randomised, blinded clinical trialKristian D. Friesgaard0Lone D. Brix1Christina B. Kristensen2Omar Rian3Lone Nikolajsen4Department of Anaesthesiology and Intensive Care, Horsens Regional Hospital, Horsens, Denmark; Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Corresponding author. Department of Anaesthesiology and Intensive Care, Horsens Regional Hospital, Horsens, Denmark.Department of Anaesthesiology and Intensive Care, Horsens Regional Hospital, Horsens, DenmarkDepartment of Gynaecology, Horsens Regional Hospital, Horsens, DenmarkDepartment of Anaesthesiology and Intensive Care, Horsens Regional Hospital, Horsens, Denmark; Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, DenmarkDepartment of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, DenmarkBackground: Laparoscopic hysterectomy is often carried out as day-stay surgery. Minimising postoperative pain is therefore of utmost importance to ensure timely discharge from hospital. Methadone has several desirable pharmacological features, including a long elimination half-life. Therefore, a single intraoperative dose could provide long-lasting pain relief. Methods: Patients scheduled to undergo laparoscopic hysterectomy were randomly allocated to receive methadone (0.2 mg kg−1) or morphine (0.2 mg kg−1) intraoperatively, 60 min before tracheal extubation. Primary outcomes were opioid consumption (oral morphine equivalents in milligrams) at 6 and 24 h. Secondary outcomes included pain intensity at rest and during coughing, patient satisfaction, postoperative nausea and vomiting, and adverse events up to 72 h after completion of surgery. Results: The postoperative median opioid consumption was reduced in the methadone group compared with the morphine group at 6 h (35.5 [0–61] mg vs 48 [31–74.5] mg; P=0.01) and 24 h (42 [10–67] mg vs 54.5 [31–83] mg; P=0.03). On arrival at the PACU, pain at rest was significantly lower in patients receiving methadone (numeric rating scale: 3 [2–5] vs 5 [3–6]), whereas pain scores at rest and coughing were not significantly different throughout the rest of the observation period. No differences in other secondary outcomes were found. Conclusions: In this randomised, blinded, controlled trial, opioid consumption was reduced during the first 24 postoperative hours in patients receiving methadone without causing an increase in adverse events. The difference observed might be considered as small and of limited clinical relevance. Clinical trial registration: NCT03908060; EudraCT no. 2018-004351-20.http://www.sciencedirect.com/science/article/pii/S2772609623000989acute postoperative painlaparoscopymethadonepain managementpostoperative |
| spellingShingle | Kristian D. Friesgaard Lone D. Brix Christina B. Kristensen Omar Rian Lone Nikolajsen Clinical effectiveness and safety of intraoperative methadone in patients undergoing laparoscopic hysterectomy: a randomised, blinded clinical trial BJA Open acute postoperative pain laparoscopy methadone pain management postoperative |
| title | Clinical effectiveness and safety of intraoperative methadone in patients undergoing laparoscopic hysterectomy: a randomised, blinded clinical trial |
| title_full | Clinical effectiveness and safety of intraoperative methadone in patients undergoing laparoscopic hysterectomy: a randomised, blinded clinical trial |
| title_fullStr | Clinical effectiveness and safety of intraoperative methadone in patients undergoing laparoscopic hysterectomy: a randomised, blinded clinical trial |
| title_full_unstemmed | Clinical effectiveness and safety of intraoperative methadone in patients undergoing laparoscopic hysterectomy: a randomised, blinded clinical trial |
| title_short | Clinical effectiveness and safety of intraoperative methadone in patients undergoing laparoscopic hysterectomy: a randomised, blinded clinical trial |
| title_sort | clinical effectiveness and safety of intraoperative methadone in patients undergoing laparoscopic hysterectomy a randomised blinded clinical trial |
| topic | acute postoperative pain laparoscopy methadone pain management postoperative |
| url | http://www.sciencedirect.com/science/article/pii/S2772609623000989 |
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