Exploring the Potential of Methadone in Postoperative Pain Management: a Comprehensive Review of Efficacy, Safety, and Dosing Strategies
Keywords:
intraoperative analgesia, methadone, multimodal analgesia, opioid-sparing, post- operative pain managementAbstract
Postoperative pain management is crucial for ensuring patient comfort, promoting recovery, and preventing complications such as delayed mobilization and hospital readmission. While opioids are the standard of care for severe postoperative pain, issues such as opioid tolerance, hyperalgesia, and adverse effects like sedation and respiratory depression complicate their use. Methadone, a synthetic opioid with NMDA receptor antagonism properties, has emerged as a promising alternative due to its long elimination half-life and multi-target effects. This review evaluates the current evidence supporting methadone use in intraoperative analgesia and its subsequent impact on postoperative pain relief. We highlight the pharmacodynamics, clinical efficacy, dosing strategies, safety profile, and comparison with traditional opioids. Methadone offers sustained analgesia, reduces opioid consumption, and shows potential for opioid-sparing strategies. However, its use requires careful monitoring due to risks such as respiratory depression and arrhythmias, especially in certain populations, such as the elderly or obese. The variability in individual response due to genetic factors, such as polymorphisms in the CYP2B6 gene, must also be considered. Continued research is needed to optimize dosing protocols and fully establish methadone’s role in postoperative pain management.
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