Safety profile of intraoperative methadone for analgesia after major spine surgery: An observational study of 1,478 patients

Authors

  • Lauren K. Dunn, MD, PhD
  • Sandeep Yerra, MBBS
  • Shenghao Fang, MSc
  • Mark F. Hanak, BS
  • Maren K. Leibowitz, BS
  • Salome B. Alpert, PhD
  • Siny Tsang, PhD
  • Marcel E. Durieux, MD, PhD
  • Edward C. Nemergut, MD
  • Bhiken I. Naik, MBBCh

DOI:

https://doi.org/10.5055/jom.2018.0435

Keywords:

methadone, opioid, chronic pain, spine surgery

Abstract

Objective: To investigate the incidence of perioperative adverse events in patients receiving intravenous methadone for major spine surgery.

Design: Retrospective review of perioperative records from March 2011 and February 2016.

Setting: University of Virginia Healthsystem.

Patients: Adult patients undergoing elective spinal fusion of two or more levels. Main Outcome Measures: Incidence of respiratory depression, time to extubation, hypotension, hypoxemia, reintubation, cardiac complications, and death.

Results: Reviewed 1,478 patient records. Mean intraoperative methadone dose was 0.14 ± 0.07 mg/kg. A total of 1,142 patients (77.4 percent) were extubated in the operating room, 543 (36.8 percent) experienced respiratory depression, 1,180 (79.8 percent) hypoxemia, and 22 (1.5 percent) required reintubation. Cardiac complications included arrhythmias (289 patients, 29.9 percent), QTc prolongation (568 patients, 58.8 percent), and myocardial infarction (16 patients, 1.1 percent). Two in hospital deaths occurred (0.14 percent).

Conclusions: Mild-moderate respiratory depression is observed following a onetime dose of intraoperative methadone, and monitoring in an appropriate postoperative setting is recommended.

Author Biographies

Lauren K. Dunn, MD, PhD

Department of Anesthesiology, University of Virginia, Charlottesville, Virginia

Sandeep Yerra, MBBS

Department of Anesthesiology, University of Virginia, Charlottesville, Virginia

Shenghao Fang, MSc

Department of Anesthesiology, University of Virginia, Charlottesville, Virginia

Mark F. Hanak, BS

Department of Anesthesiology, University of Virginia, Charlottesville, Virginia

Maren K. Leibowitz, BS

Department of Anesthesiology, University of Virginia, Charlottesville, Virginia

Salome B. Alpert, PhD

Department of Anesthesiology, University of Virginia, Charlottesville, Virginia

Siny Tsang, PhD

Department of Epidemiology, Columbia University, New York, New York

Marcel E. Durieux, MD, PhD

Department of Anesthesiology, University of Virginia, Charlottesville, Virginia; Department of Neurosurgery, University of Virginia, Charlottesville, Virginia

Edward C. Nemergut, MD

Department of Anesthesiology, University of Virginia, Charlottesville, Virginia; Department of Neurosurgery, University of Virginia, Charlottesville, Virginia

Bhiken I. Naik, MBBCh

Department of Anesthesiology, University of Virginia, Charlottesville, Virginia; Department of Neurosurgery, University of Virginia, Charlottesville, Virginia

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Published

03/01/2018

How to Cite

Dunn, MD, PhD, L. K., S. Yerra, MBBS, S. Fang, MSc, M. F. Hanak, BS, M. K. Leibowitz, BS, S. B. Alpert, PhD, S. Tsang, PhD, M. E. Durieux, MD, PhD, E. C. Nemergut, MD, and B. I. Naik, MBBCh. “Safety Profile of Intraoperative Methadone for Analgesia After Major Spine Surgery: An Observational Study of 1,478 Patients”. Journal of Opioid Management, vol. 14, no. 2, Mar. 2018, pp. 83-87, doi:10.5055/jom.2018.0435.

Issue

Vol. 14 No. 2 (2018): March/April

Section

Brief Communication

License

Copyright 2005-2024, Weston Medical Publishing, LLC
All Rights Reserved

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