Intraoperative methadone administration for total mastectomy: A single center retrospective study
Breast cancer is the most frequent type of cancer and the second leading cause of cancer-related mortality in women. Mastectomies remain a key component of the treatment of non-metastatic breast cancer, and strategies to treat acute postoperative pain, a complication affecting nearly all patients un...
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| Veröffentlicht in: | Journal of clinical anesthesia 2024-11, Vol.98, p.111572, Article 111572 |
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| creator | Cata, Juan P. Zaidi, Yusuf Guerra-Londono, Juan Jose Kharasch, Evan D. Piotrowski, Matthew Kee, Spencer Cortes-Mejia, Nicolas A. Gloria-Escobar, Jose Miguel Thall, Peter F. Lin, Ruitao |
| description | Breast cancer is the most frequent type of cancer and the second leading cause of cancer-related mortality in women. Mastectomies remain a key component of the treatment of non-metastatic breast cancer, and strategies to treat acute postoperative pain, a complication affecting nearly all patients undergoing surgery, continues to be an important clinical challenge. This study aimed to determine the impact of intraoperative methadone administration compared to conventional short-acting opioids on pain-related perioperative outcomes in women undergoing a mastectomy.
This single-center retrospective study included adult women undergoing total mastectomy. The primary outcome of this study was postoperative pain intensity on day 1 after surgery. Secondary outcomes included perioperative opioid consumption, perioperative non-opioid analgesics use, duration of surgery and anesthesia, time to extubation, pain intensity in the postanesthesia care unit (PACU), anti-emetic use in PACU, and length of stay in hospital. We used the propensity score-based nearest matching with a 1:3 ratio to balance the patient baseline characteristics.
133 patients received methadone, and 2192 patients were treated with short-acting opioids. The analysis demonstrated that methadone was associated with significantly lower intraoperative and postoperative opioid consumption as measured by oral morphine equivalents and lower average pain intensity scores in the postanesthesia care unit. Moreover, methadone was also shown to reduce the use of non-opioid analgesia during surgery.
Our study suggests that the unique pharmacological properties of methadone, including a short onset of action when given intravenously, long-acting pharmacokinetics, and multimodal effects, are associated with better acute pain management after a total mastectomy.
•Methadone was associated with significantly less perioperative opioid consumption than short-acting opioids.•Methadone was associated with less use of non-opioid analgesia.•Methadone was associated with lower average pain intensity scores. |
| doi_str_mv | 10.1016/j.jclinane.2024.111572 |
| format | Article |
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This single-center retrospective study included adult women undergoing total mastectomy. The primary outcome of this study was postoperative pain intensity on day 1 after surgery. Secondary outcomes included perioperative opioid consumption, perioperative non-opioid analgesics use, duration of surgery and anesthesia, time to extubation, pain intensity in the postanesthesia care unit (PACU), anti-emetic use in PACU, and length of stay in hospital. We used the propensity score-based nearest matching with a 1:3 ratio to balance the patient baseline characteristics.
133 patients received methadone, and 2192 patients were treated with short-acting opioids. The analysis demonstrated that methadone was associated with significantly lower intraoperative and postoperative opioid consumption as measured by oral morphine equivalents and lower average pain intensity scores in the postanesthesia care unit. Moreover, methadone was also shown to reduce the use of non-opioid analgesia during surgery.
Our study suggests that the unique pharmacological properties of methadone, including a short onset of action when given intravenously, long-acting pharmacokinetics, and multimodal effects, are associated with better acute pain management after a total mastectomy.
•Methadone was associated with significantly less perioperative opioid consumption than short-acting opioids.•Methadone was associated with less use of non-opioid analgesia.•Methadone was associated with lower average pain intensity scores.</description><identifier>ISSN: 0952-8180</identifier><identifier>ISSN: 1873-4529</identifier><identifier>EISSN: 1873-4529</identifier><identifier>DOI: 10.1016/j.jclinane.2024.111572</identifier><identifier>PMID: 39180867</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Analgesics ; Analgesics, Opioid - administration & dosage ; Body mass index ; Breast cancer ; Breast Neoplasms - surgery ; Cancer therapies ; Chemotherapy ; Clinical outcomes ; Comorbidity ; Drug dosages ; Ethnicity ; Extubation ; Female ; Fentanyl ; General anesthesia ; Humans ; Intraoperative Care - methods ; Length of stay ; Length of Stay - statistics & numerical data ; Mastectomy ; Mastectomy - adverse effects ; Methadone ; Methadone - administration & dosage ; Middle Aged ; Morphine ; Narcotics ; Pain management ; Pain Management - methods ; Pain Measurement - statistics & numerical data ; Pain, Postoperative - drug therapy ; Pain, Postoperative - etiology ; Pain, Postoperative - prevention & control ; Patients ; Perioperative care ; Postoperative period ; Regional anesthesia ; Retrospective Studies ; Surgery ; Treatment Outcome</subject><ispartof>Journal of clinical anesthesia, 2024-11, Vol.98, p.111572, Article 111572</ispartof><rights>2024 Elsevier Inc.</rights><rights>Copyright © 2024 Elsevier Inc. All rights reserved.</rights><rights>2024. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c273t-b06adcb19f8694ec9f4868818183c6addf98c00c91336f0b505c50f0ff66389d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/3102712648?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974,64362,64364,64366,72216</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39180867$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cata, Juan P.</creatorcontrib><creatorcontrib>Zaidi, Yusuf</creatorcontrib><creatorcontrib>Guerra-Londono, Juan Jose</creatorcontrib><creatorcontrib>Kharasch, Evan D.</creatorcontrib><creatorcontrib>Piotrowski, Matthew</creatorcontrib><creatorcontrib>Kee, Spencer</creatorcontrib><creatorcontrib>Cortes-Mejia, Nicolas A.</creatorcontrib><creatorcontrib>Gloria-Escobar, Jose Miguel</creatorcontrib><creatorcontrib>Thall, Peter F.</creatorcontrib><creatorcontrib>Lin, Ruitao</creatorcontrib><title>Intraoperative methadone administration for total mastectomy: A single center retrospective study</title><title>Journal of clinical anesthesia</title><addtitle>J Clin Anesth</addtitle><description>Breast cancer is the most frequent type of cancer and the second leading cause of cancer-related mortality in women. Mastectomies remain a key component of the treatment of non-metastatic breast cancer, and strategies to treat acute postoperative pain, a complication affecting nearly all patients undergoing surgery, continues to be an important clinical challenge. This study aimed to determine the impact of intraoperative methadone administration compared to conventional short-acting opioids on pain-related perioperative outcomes in women undergoing a mastectomy.
This single-center retrospective study included adult women undergoing total mastectomy. The primary outcome of this study was postoperative pain intensity on day 1 after surgery. Secondary outcomes included perioperative opioid consumption, perioperative non-opioid analgesics use, duration of surgery and anesthesia, time to extubation, pain intensity in the postanesthesia care unit (PACU), anti-emetic use in PACU, and length of stay in hospital. We used the propensity score-based nearest matching with a 1:3 ratio to balance the patient baseline characteristics.
133 patients received methadone, and 2192 patients were treated with short-acting opioids. The analysis demonstrated that methadone was associated with significantly lower intraoperative and postoperative opioid consumption as measured by oral morphine equivalents and lower average pain intensity scores in the postanesthesia care unit. Moreover, methadone was also shown to reduce the use of non-opioid analgesia during surgery.
Our study suggests that the unique pharmacological properties of methadone, including a short onset of action when given intravenously, long-acting pharmacokinetics, and multimodal effects, are associated with better acute pain management after a total mastectomy.
•Methadone was associated with significantly less perioperative opioid consumption than short-acting opioids.•Methadone was associated with less use of non-opioid analgesia.•Methadone was associated with lower average pain intensity scores.</description><subject>Adult</subject><subject>Aged</subject><subject>Analgesics</subject><subject>Analgesics, Opioid - administration & dosage</subject><subject>Body mass index</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - surgery</subject><subject>Cancer therapies</subject><subject>Chemotherapy</subject><subject>Clinical outcomes</subject><subject>Comorbidity</subject><subject>Drug dosages</subject><subject>Ethnicity</subject><subject>Extubation</subject><subject>Female</subject><subject>Fentanyl</subject><subject>General anesthesia</subject><subject>Humans</subject><subject>Intraoperative Care - methods</subject><subject>Length of stay</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Mastectomy</subject><subject>Mastectomy - adverse effects</subject><subject>Methadone</subject><subject>Methadone - administration & dosage</subject><subject>Middle Aged</subject><subject>Morphine</subject><subject>Narcotics</subject><subject>Pain management</subject><subject>Pain Management - methods</subject><subject>Pain Measurement - statistics & numerical data</subject><subject>Pain, Postoperative - drug therapy</subject><subject>Pain, Postoperative - etiology</subject><subject>Pain, Postoperative - prevention & control</subject><subject>Patients</subject><subject>Perioperative care</subject><subject>Postoperative period</subject><subject>Regional anesthesia</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>0952-8180</issn><issn>1873-4529</issn><issn>1873-4529</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkc2OFCEUhYnROG3rK0xI3Lip9lJUUeDKycSfSSZxo2tCUxelUgUtUJP020ulZ1y4cUXC-e7hcg4h1wwODJh4Px0mO_tgAh5aaLsDY6wf2mdkx-TAm65v1XOyA9W3jWQSrsirnCcAqAJ7Sa64qpdSDDti7kJJJp4wmeIfkC5YfpkxBqRmXHzwuWxCDNTFREssZqaLyQVticv5A72h2YefM1KLoWCiCUuK-VTlzSyXdTy_Ji-cmTO-eTz35MfnT99vvzb3377c3d7cN7YdeGmOIMxoj0w5KVSHVrlOClmXZ5LbKo1OSQtgFeNcODj20NseHDgnBJdq5Hvy7uJ7SvH3irnoxWeL81wzimvWHNTAuqGrfnvy9h90imsKdTvNGbQDa0W3UeJC2fqlnNDpU_KLSWfNQG8l6Ek_laC3EvSlhDp4_Wi_Hhcc_449pV6BjxcAax4PHpPO1mOwOPpUo9Nj9P974w_U05ya</recordid><startdate>202411</startdate><enddate>202411</enddate><creator>Cata, Juan P.</creator><creator>Zaidi, Yusuf</creator><creator>Guerra-Londono, Juan Jose</creator><creator>Kharasch, Evan D.</creator><creator>Piotrowski, Matthew</creator><creator>Kee, Spencer</creator><creator>Cortes-Mejia, Nicolas A.</creator><creator>Gloria-Escobar, Jose Miguel</creator><creator>Thall, Peter F.</creator><creator>Lin, Ruitao</creator><general>Elsevier Inc</general><general>Elsevier Limited</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>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202411</creationdate><title>Intraoperative methadone administration for total mastectomy: A single center retrospective study</title><author>Cata, Juan P. ; Zaidi, Yusuf ; Guerra-Londono, Juan Jose ; Kharasch, Evan D. ; Piotrowski, Matthew ; Kee, Spencer ; Cortes-Mejia, Nicolas A. ; Gloria-Escobar, Jose Miguel ; Thall, Peter F. ; Lin, Ruitao</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c273t-b06adcb19f8694ec9f4868818183c6addf98c00c91336f0b505c50f0ff66389d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Analgesics</topic><topic>Analgesics, Opioid - administration & dosage</topic><topic>Body mass index</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - surgery</topic><topic>Cancer therapies</topic><topic>Chemotherapy</topic><topic>Clinical outcomes</topic><topic>Comorbidity</topic><topic>Drug dosages</topic><topic>Ethnicity</topic><topic>Extubation</topic><topic>Female</topic><topic>Fentanyl</topic><topic>General anesthesia</topic><topic>Humans</topic><topic>Intraoperative Care - methods</topic><topic>Length of stay</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Mastectomy</topic><topic>Mastectomy - adverse effects</topic><topic>Methadone</topic><topic>Methadone - administration & dosage</topic><topic>Middle Aged</topic><topic>Morphine</topic><topic>Narcotics</topic><topic>Pain management</topic><topic>Pain Management - methods</topic><topic>Pain Measurement - statistics & numerical data</topic><topic>Pain, Postoperative - drug therapy</topic><topic>Pain, Postoperative - etiology</topic><topic>Pain, Postoperative - 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Academic</collection><jtitle>Journal of clinical anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cata, Juan P.</au><au>Zaidi, Yusuf</au><au>Guerra-Londono, Juan Jose</au><au>Kharasch, Evan D.</au><au>Piotrowski, Matthew</au><au>Kee, Spencer</au><au>Cortes-Mejia, Nicolas A.</au><au>Gloria-Escobar, Jose Miguel</au><au>Thall, Peter F.</au><au>Lin, Ruitao</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intraoperative methadone administration for total mastectomy: A single center retrospective study</atitle><jtitle>Journal of clinical anesthesia</jtitle><addtitle>J Clin Anesth</addtitle><date>2024-11</date><risdate>2024</risdate><volume>98</volume><spage>111572</spage><pages>111572-</pages><artnum>111572</artnum><issn>0952-8180</issn><issn>1873-4529</issn><eissn>1873-4529</eissn><abstract>Breast cancer is the most frequent type of cancer and the second leading cause of cancer-related mortality in women. Mastectomies remain a key component of the treatment of non-metastatic breast cancer, and strategies to treat acute postoperative pain, a complication affecting nearly all patients undergoing surgery, continues to be an important clinical challenge. This study aimed to determine the impact of intraoperative methadone administration compared to conventional short-acting opioids on pain-related perioperative outcomes in women undergoing a mastectomy.
This single-center retrospective study included adult women undergoing total mastectomy. The primary outcome of this study was postoperative pain intensity on day 1 after surgery. Secondary outcomes included perioperative opioid consumption, perioperative non-opioid analgesics use, duration of surgery and anesthesia, time to extubation, pain intensity in the postanesthesia care unit (PACU), anti-emetic use in PACU, and length of stay in hospital. We used the propensity score-based nearest matching with a 1:3 ratio to balance the patient baseline characteristics.
133 patients received methadone, and 2192 patients were treated with short-acting opioids. The analysis demonstrated that methadone was associated with significantly lower intraoperative and postoperative opioid consumption as measured by oral morphine equivalents and lower average pain intensity scores in the postanesthesia care unit. Moreover, methadone was also shown to reduce the use of non-opioid analgesia during surgery.
Our study suggests that the unique pharmacological properties of methadone, including a short onset of action when given intravenously, long-acting pharmacokinetics, and multimodal effects, are associated with better acute pain management after a total mastectomy.
•Methadone was associated with significantly less perioperative opioid consumption than short-acting opioids.•Methadone was associated with less use of non-opioid analgesia.•Methadone was associated with lower average pain intensity scores.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>39180867</pmid><doi>10.1016/j.jclinane.2024.111572</doi></addata></record> |
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| subjects | Adult Aged Analgesics Analgesics, Opioid - administration & dosage Body mass index Breast cancer Breast Neoplasms - surgery Cancer therapies Chemotherapy Clinical outcomes Comorbidity Drug dosages Ethnicity Extubation Female Fentanyl General anesthesia Humans Intraoperative Care - methods Length of stay Length of Stay - statistics & numerical data Mastectomy Mastectomy - adverse effects Methadone Methadone - administration & dosage Middle Aged Morphine Narcotics Pain management Pain Management - methods Pain Measurement - statistics & numerical data Pain, Postoperative - drug therapy Pain, Postoperative - etiology Pain, Postoperative - prevention & control Patients Perioperative care Postoperative period Regional anesthesia Retrospective Studies Surgery Treatment Outcome |
| title | Intraoperative methadone administration for total mastectomy: A single center retrospective study |
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