Intra‐operative methadone effect on quality of recovery compared with morphine following laparoscopic gastroplasty: a randomised controlled trial
Summary The effect of intra‐operative intravenous methadone on quality of postoperative recovery was compared with morphine after laparoscopic gastroplasty. We included 137 adult patients with a body mass index > 35 kg.m−2 who underwent bariatric surgery. Patients were allocated at random to rece...
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| Veröffentlicht in: | Anaesthesia 2021-02, Vol.76 (2), p.199-208 |
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| creator | Pontes, J. P. J. Braz, F. R. Módolo, N. S. P. Mattar, L. A. Sousa, J. A. G. Navarro e Lima, L. H. |
| description | Summary
The effect of intra‐operative intravenous methadone on quality of postoperative recovery was compared with morphine after laparoscopic gastroplasty. We included 137 adult patients with a body mass index > 35 kg.m−2 who underwent bariatric surgery. Patients were allocated at random to receive either intra‐operative methadone (n = 69) or morphine (n = 68). All patients received the same postoperative care and analgesia. The primary outcome of postoperative quality of recovery was assessed using the Quality of Recovery‐40 questionnaire total score 24 h after surgery. Secondary outcomes were assessed in the post‐anaesthesia care unit the night of the day of surgery (T1), in the morning after surgery (T2); and at night on the day following surgery (T3). The median (IQR [range]) total Quality of Recovery‐40 questionnaire score of 194 (190–197 [165–200]) was higher (p |
| doi_str_mv | 10.1111/anae.15173 |
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The effect of intra‐operative intravenous methadone on quality of postoperative recovery was compared with morphine after laparoscopic gastroplasty. We included 137 adult patients with a body mass index > 35 kg.m−2 who underwent bariatric surgery. Patients were allocated at random to receive either intra‐operative methadone (n = 69) or morphine (n = 68). All patients received the same postoperative care and analgesia. The primary outcome of postoperative quality of recovery was assessed using the Quality of Recovery‐40 questionnaire total score 24 h after surgery. Secondary outcomes were assessed in the post‐anaesthesia care unit the night of the day of surgery (T1), in the morning after surgery (T2); and at night on the day following surgery (T3). The median (IQR [range]) total Quality of Recovery‐40 questionnaire score of 194 (190–197 [165–200]) was higher (p < 0.0001) in the methadone group compared with the score of 181 (174–185.5 [121–200]) in the morphine group. In the post‐anaesthesia care unit, the pain burden; incidence of nausea and vomiting; rescue morphine dose; and time to discharge, were significantly lower in the methadone group. On the ward, the methadone group had a lower: incidence of rescue morphine requests at T1 (5.8 vs. 54.4%, p < 0.0001) and T2 (0 vs. 20.1%, p < 0.0001); and incidence of nausea (21.7 vs. 41.2%, p = 0.014), compared with the morphine group. We conclude that intra‐operative intravenous methadone improved quality of recovery in patients who underwent laparoscopic gastroplasty, compared with intra‐operative morphine. Methadone also reduced postoperative pain, postoperative opioid consumption and the incidence of opioid‐related adverse events.</description><identifier>ISSN: 0003-2409</identifier><identifier>EISSN: 1365-2044</identifier><identifier>DOI: 10.1111/anae.15173</identifier><identifier>PMID: 32803791</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Adult ; Analgesia ; Analgesia, Patient-Controlled ; Analgesics, Opioid - adverse effects ; Analgesics, Opioid - therapeutic use ; Anesthesia ; Anesthesia Recovery Period ; bariatric surgery ; Body mass ; Body mass index ; Body size ; Double-Blind Method ; Female ; Gastrointestinal surgery ; Gastroplasty - methods ; Humans ; Intraoperative Period ; Intravenous administration ; Laparoscopy ; Laparoscopy - methods ; Male ; Methadone ; Methadone - adverse effects ; Methadone - therapeutic use ; Middle Aged ; morbid ; Morphine ; Morphine - adverse effects ; Morphine - therapeutic use ; Narcotics ; Nausea ; Night ; Obesity ; Opioids ; Pain ; Pain Management ; Pain Measurement - drug effects ; Pain perception ; Pain, Postoperative - drug therapy ; Pain, Postoperative - epidemiology ; patient reported outcome measures ; Postoperative Nausea and Vomiting - epidemiology ; Quality assessment ; quality measures: patient care ; Questionnaires ; Recovery (Medical) ; Surgery ; Treatment Outcome ; Vomiting</subject><ispartof>Anaesthesia, 2021-02, Vol.76 (2), p.199-208</ispartof><rights>2020 Association of Anaesthetists</rights><rights>2020 Association of Anaesthetists.</rights><rights>Copyright © 2021 Association of Anaesthetists</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3573-48b287dcda5c3f09a5cd0516412ccbabc72e88bc9ef2d17f01297e7abb077b373</citedby><cites>FETCH-LOGICAL-c3573-48b287dcda5c3f09a5cd0516412ccbabc72e88bc9ef2d17f01297e7abb077b373</cites><orcidid>0000-0002-8365-5250 ; 0000-0002-3575-4182 ; 0000-0002-9135-4407 ; 0000-0003-3428-0664 ; 0000-0002-8549-6820 ; 0000-0001-9596-7289</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fanae.15173$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fanae.15173$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,1433,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32803791$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pontes, J. P. J.</creatorcontrib><creatorcontrib>Braz, F. R.</creatorcontrib><creatorcontrib>Módolo, N. S. P.</creatorcontrib><creatorcontrib>Mattar, L. A.</creatorcontrib><creatorcontrib>Sousa, J. A. G.</creatorcontrib><creatorcontrib>Navarro e Lima, L. H.</creatorcontrib><title>Intra‐operative methadone effect on quality of recovery compared with morphine following laparoscopic gastroplasty: a randomised controlled trial</title><title>Anaesthesia</title><addtitle>Anaesthesia</addtitle><description>Summary
The effect of intra‐operative intravenous methadone on quality of postoperative recovery was compared with morphine after laparoscopic gastroplasty. We included 137 adult patients with a body mass index > 35 kg.m−2 who underwent bariatric surgery. Patients were allocated at random to receive either intra‐operative methadone (n = 69) or morphine (n = 68). All patients received the same postoperative care and analgesia. The primary outcome of postoperative quality of recovery was assessed using the Quality of Recovery‐40 questionnaire total score 24 h after surgery. Secondary outcomes were assessed in the post‐anaesthesia care unit the night of the day of surgery (T1), in the morning after surgery (T2); and at night on the day following surgery (T3). The median (IQR [range]) total Quality of Recovery‐40 questionnaire score of 194 (190–197 [165–200]) was higher (p < 0.0001) in the methadone group compared with the score of 181 (174–185.5 [121–200]) in the morphine group. In the post‐anaesthesia care unit, the pain burden; incidence of nausea and vomiting; rescue morphine dose; and time to discharge, were significantly lower in the methadone group. On the ward, the methadone group had a lower: incidence of rescue morphine requests at T1 (5.8 vs. 54.4%, p < 0.0001) and T2 (0 vs. 20.1%, p < 0.0001); and incidence of nausea (21.7 vs. 41.2%, p = 0.014), compared with the morphine group. We conclude that intra‐operative intravenous methadone improved quality of recovery in patients who underwent laparoscopic gastroplasty, compared with intra‐operative morphine. Methadone also reduced postoperative pain, postoperative opioid consumption and the incidence of opioid‐related adverse events.</description><subject>Adult</subject><subject>Analgesia</subject><subject>Analgesia, Patient-Controlled</subject><subject>Analgesics, Opioid - adverse effects</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Anesthesia</subject><subject>Anesthesia Recovery Period</subject><subject>bariatric surgery</subject><subject>Body mass</subject><subject>Body mass index</subject><subject>Body size</subject><subject>Double-Blind Method</subject><subject>Female</subject><subject>Gastrointestinal surgery</subject><subject>Gastroplasty - methods</subject><subject>Humans</subject><subject>Intraoperative Period</subject><subject>Intravenous administration</subject><subject>Laparoscopy</subject><subject>Laparoscopy - methods</subject><subject>Male</subject><subject>Methadone</subject><subject>Methadone - adverse effects</subject><subject>Methadone - therapeutic use</subject><subject>Middle Aged</subject><subject>morbid</subject><subject>Morphine</subject><subject>Morphine - adverse effects</subject><subject>Morphine - therapeutic use</subject><subject>Narcotics</subject><subject>Nausea</subject><subject>Night</subject><subject>Obesity</subject><subject>Opioids</subject><subject>Pain</subject><subject>Pain Management</subject><subject>Pain Measurement - drug effects</subject><subject>Pain perception</subject><subject>Pain, Postoperative - drug therapy</subject><subject>Pain, Postoperative - epidemiology</subject><subject>patient reported outcome measures</subject><subject>Postoperative Nausea and Vomiting - epidemiology</subject><subject>Quality assessment</subject><subject>quality measures: patient care</subject><subject>Questionnaires</subject><subject>Recovery (Medical)</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Vomiting</subject><issn>0003-2409</issn><issn>1365-2044</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1KxDAUhYMoOv5sfAAJuBOq-WknrbtB_APRja7LbXrjRNqmphmH7nwEwTf0SYyOujSbE8h3zs09hOxzdszjOYEO8JhnXMk1MuFymiWCpek6mTDGZCJSVmyR7WF4YoyLnOebZEuKnElV8Al5v-6Ch4_XN9ejh2BfkLYY5lC7DikagzpQ19HnBTQ2jNQZ6lG7F_Qj1a7twWNNlzbMaet8P7fRZFzTuKXtHmkD8d0N2vVW00cYgnd9E2U8pUA9dLVr7RD92sU_RFe8Bm-h2SUbBpoB9350hzxcnN-fXSU3d5fXZ7ObRMtMySTNK5GrWteQaWlYEaVmGZ-mXGhdQaWVwDyvdIFG1FyZuH2hUEFVMaUqqeQOOVzl9t49L3AI5ZNb-C6OLEWqplIyMS0idbSidNxl8GjK3tsW_FhyVn71X371X373H-GDn8hF1WL9h_4WHgG-Apa2wfGfqHJ2OztfhX4CQYiVeQ</recordid><startdate>202102</startdate><enddate>202102</enddate><creator>Pontes, J. P. J.</creator><creator>Braz, F. R.</creator><creator>Módolo, N. S. P.</creator><creator>Mattar, L. A.</creator><creator>Sousa, J. A. G.</creator><creator>Navarro e Lima, L. H.</creator><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><orcidid>https://orcid.org/0000-0002-8365-5250</orcidid><orcidid>https://orcid.org/0000-0002-3575-4182</orcidid><orcidid>https://orcid.org/0000-0002-9135-4407</orcidid><orcidid>https://orcid.org/0000-0003-3428-0664</orcidid><orcidid>https://orcid.org/0000-0002-8549-6820</orcidid><orcidid>https://orcid.org/0000-0001-9596-7289</orcidid></search><sort><creationdate>202102</creationdate><title>Intra‐operative methadone effect on quality of recovery compared with morphine following laparoscopic gastroplasty: a randomised controlled trial</title><author>Pontes, J. P. J. ; Braz, F. R. ; Módolo, N. S. P. ; Mattar, L. A. ; Sousa, J. A. G. ; Navarro e Lima, L. H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3573-48b287dcda5c3f09a5cd0516412ccbabc72e88bc9ef2d17f01297e7abb077b373</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Analgesia</topic><topic>Analgesia, Patient-Controlled</topic><topic>Analgesics, Opioid - adverse effects</topic><topic>Analgesics, Opioid - therapeutic use</topic><topic>Anesthesia</topic><topic>Anesthesia Recovery Period</topic><topic>bariatric surgery</topic><topic>Body mass</topic><topic>Body mass index</topic><topic>Body size</topic><topic>Double-Blind Method</topic><topic>Female</topic><topic>Gastrointestinal surgery</topic><topic>Gastroplasty - methods</topic><topic>Humans</topic><topic>Intraoperative Period</topic><topic>Intravenous administration</topic><topic>Laparoscopy</topic><topic>Laparoscopy - methods</topic><topic>Male</topic><topic>Methadone</topic><topic>Methadone - adverse effects</topic><topic>Methadone - therapeutic use</topic><topic>Middle Aged</topic><topic>morbid</topic><topic>Morphine</topic><topic>Morphine - adverse effects</topic><topic>Morphine - therapeutic use</topic><topic>Narcotics</topic><topic>Nausea</topic><topic>Night</topic><topic>Obesity</topic><topic>Opioids</topic><topic>Pain</topic><topic>Pain Management</topic><topic>Pain Measurement - drug effects</topic><topic>Pain perception</topic><topic>Pain, Postoperative - drug therapy</topic><topic>Pain, Postoperative - epidemiology</topic><topic>patient reported outcome measures</topic><topic>Postoperative Nausea and Vomiting - epidemiology</topic><topic>Quality assessment</topic><topic>quality measures: patient care</topic><topic>Questionnaires</topic><topic>Recovery (Medical)</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>Vomiting</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pontes, J. P. J.</creatorcontrib><creatorcontrib>Braz, F. R.</creatorcontrib><creatorcontrib>Módolo, N. S. P.</creatorcontrib><creatorcontrib>Mattar, L. A.</creatorcontrib><creatorcontrib>Sousa, J. A. G.</creatorcontrib><creatorcontrib>Navarro e Lima, L. H.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><jtitle>Anaesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pontes, J. P. J.</au><au>Braz, F. R.</au><au>Módolo, N. S. P.</au><au>Mattar, L. A.</au><au>Sousa, J. A. G.</au><au>Navarro e Lima, L. H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intra‐operative methadone effect on quality of recovery compared with morphine following laparoscopic gastroplasty: a randomised controlled trial</atitle><jtitle>Anaesthesia</jtitle><addtitle>Anaesthesia</addtitle><date>2021-02</date><risdate>2021</risdate><volume>76</volume><issue>2</issue><spage>199</spage><epage>208</epage><pages>199-208</pages><issn>0003-2409</issn><eissn>1365-2044</eissn><abstract>Summary
The effect of intra‐operative intravenous methadone on quality of postoperative recovery was compared with morphine after laparoscopic gastroplasty. We included 137 adult patients with a body mass index > 35 kg.m−2 who underwent bariatric surgery. Patients were allocated at random to receive either intra‐operative methadone (n = 69) or morphine (n = 68). All patients received the same postoperative care and analgesia. The primary outcome of postoperative quality of recovery was assessed using the Quality of Recovery‐40 questionnaire total score 24 h after surgery. Secondary outcomes were assessed in the post‐anaesthesia care unit the night of the day of surgery (T1), in the morning after surgery (T2); and at night on the day following surgery (T3). The median (IQR [range]) total Quality of Recovery‐40 questionnaire score of 194 (190–197 [165–200]) was higher (p < 0.0001) in the methadone group compared with the score of 181 (174–185.5 [121–200]) in the morphine group. In the post‐anaesthesia care unit, the pain burden; incidence of nausea and vomiting; rescue morphine dose; and time to discharge, were significantly lower in the methadone group. On the ward, the methadone group had a lower: incidence of rescue morphine requests at T1 (5.8 vs. 54.4%, p < 0.0001) and T2 (0 vs. 20.1%, p < 0.0001); and incidence of nausea (21.7 vs. 41.2%, p = 0.014), compared with the morphine group. We conclude that intra‐operative intravenous methadone improved quality of recovery in patients who underwent laparoscopic gastroplasty, compared with intra‐operative morphine. Methadone also reduced postoperative pain, postoperative opioid consumption and the incidence of opioid‐related adverse events.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>32803791</pmid><doi>10.1111/anae.15173</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-8365-5250</orcidid><orcidid>https://orcid.org/0000-0002-3575-4182</orcidid><orcidid>https://orcid.org/0000-0002-9135-4407</orcidid><orcidid>https://orcid.org/0000-0003-3428-0664</orcidid><orcidid>https://orcid.org/0000-0002-8549-6820</orcidid><orcidid>https://orcid.org/0000-0001-9596-7289</orcidid></addata></record> |
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| subjects | Adult Analgesia Analgesia, Patient-Controlled Analgesics, Opioid - adverse effects Analgesics, Opioid - therapeutic use Anesthesia Anesthesia Recovery Period bariatric surgery Body mass Body mass index Body size Double-Blind Method Female Gastrointestinal surgery Gastroplasty - methods Humans Intraoperative Period Intravenous administration Laparoscopy Laparoscopy - methods Male Methadone Methadone - adverse effects Methadone - therapeutic use Middle Aged morbid Morphine Morphine - adverse effects Morphine - therapeutic use Narcotics Nausea Night Obesity Opioids Pain Pain Management Pain Measurement - drug effects Pain perception Pain, Postoperative - drug therapy Pain, Postoperative - epidemiology patient reported outcome measures Postoperative Nausea and Vomiting - epidemiology Quality assessment quality measures: patient care Questionnaires Recovery (Medical) Surgery Treatment Outcome Vomiting |
| title | Intra‐operative methadone effect on quality of recovery compared with morphine following laparoscopic gastroplasty: a randomised controlled trial |
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