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Methadone Prior to Spinal Surgery

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Stevie View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Stevie Quote  Post ReplyReply Direct Link To This Post Topic: Methadone Prior to Spinal Surgery
    Posted: Aug/09/2011 at 5:20pm
From the Medscape Week in Review – MedPulse Newsletter August 9, 2011

In one recent study, it was found that by giving a single dose of Methadone prior to complex spinal surgery, the need for narcotics post-op was decreased.

Methadone is a long lasting narcotic, and the authors of the study concluded that "'preoperative treatment with a single dose of methadone improves postoperative pain control for patients undergoing complex spine surgery'

Something to talk to your anesthesiologist about? 

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My journey with chronic pain began over 30 years ago, while as a young nurse working spinal rehab, I injured my back lifting a patient. I am now fused from L2-S1. I have multiple thoracic and cervical issues. I'm a retired RN/PA and I know and understand the frustrations on both ends of the treatment spectrum of dealing with CP. It's been my goal since 2008, when we started this site, to reach out and help as many people in pain as possible. We will continue the fight as long as we can. Please, if you can help us continue to help you and others, donate. Thank you.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote wolfalohalani Quote  Post ReplyReply Direct Link To This Post Posted: Aug/10/2011 at 12:05pm
Hi Stevie - 

Was this instead of fentanyl, or instead of nothing? 

wolf
Ruptured L4-5 10/91 - diskectomy 2/92. Fibro started 4/92. Cervical myelopathy 12/07 - laminectomy C4-7 3/08. B12 peripheral neuropathy 6/10.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Stevie Quote  Post ReplyReply Direct Link To This Post Posted: Aug/10/2011 at 12:21pm
The article didn't say, Wolf.  It only said that a single dose of methadone prior to making the first incision.  Then of course, post op narcotics were started, but less were needed due to the longer acting duration of the methadone.  Great question, however!!

Please donate to help Chronicpainsite.com continue to help others.

My journey with chronic pain began over 30 years ago, while as a young nurse working spinal rehab, I injured my back lifting a patient. I am now fused from L2-S1. I have multiple thoracic and cervical issues. I'm a retired RN/PA and I know and understand the frustrations on both ends of the treatment spectrum of dealing with CP. It's been my goal since 2008, when we started this site, to reach out and help as many people in pain as possible. We will continue the fight as long as we can. Please, if you can help us continue to help you and others, donate. Thank you.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote wolfalohalani Quote  Post ReplyReply Direct Link To This Post Posted: Aug/10/2011 at 7:58pm
Hey Stevie - 

Here's the abstract from Medline.  Now, the question is, why is methadone better?  Is it just that complex spine surgery goes on longer, so the opiod they're comparing it to wears off?  Or is it something else, like the fact that methadone is an NMDA inhibitor, that makes the difference?

Huh, I've never had methadone.  Hopefully I won't need this kind of surgery again, but it's good to know.  Thanks for posting this!

wolf

¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬

Intraoperative methadone improves postoperative pain control in patients undergoing complex spine surgery.

Anesth Analg.  2011; 112(1):218-23 (ISSN: 1526-7598)

Gottschalk A; Durieux ME; Nemergut EC
Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA 22908, USA.

BACKGROUND: Patients undergoing complex spine surgery frequently experience severe pain in the postoperative period. The combined opiate receptor agonist/N-methyl-d-aspartate receptor antagonist methadone may be an optimal drug for these patients given the probable involvement of N-methyl-d-aspartate systems in the mechanism of opioid tolerance and hyperalgesia.

METHODS: Twenty-nine patients undergoing multilevel thoracolumbar spine surgery with instrumentation and fusion were enrolled in this prospective study and randomized to receive either methadone (0.2 mg/kg) before surgical incision or a continuous sufentanil infusion of 0.25 μg/kg/h after a load of 0.75 μg/kg. Postoperative analgesia was provided using IV opioids by patient-controlled analgesia. Patients were assessed with respect to pain scores (visual analog scale from 0 to 10), cumulative opioid requirement, and side effects at 24, 48, and 72 hours after surgery.

RESULTS: Demographic data, duration, and type of surgery were comparable between the groups. Methadone reduced postoperative opioid requirement by approximately 50% at 48 hours (sufentanil versus methadone group, median [25%/75% interquartile range]: 63 mg [27.3/86.1] vs 25 mg [16.5/31.5] morphine equivalents, P = 0.023; and 72 hours: 34 mg [19.9/91.5] vs 15 mg [8.8/27.8] morphine equivalents, P = 0.024) after surgery. In addition, pain scores were lower by approximately 50% in the methadone group at 48 hours after surgery (sufentanil versus methadone group [mean ± SD] 4.8 ± 2.4 vs 2.8 ± 2.0, P = 0.026). The incidence of side effects was comparable in both groups.

CONCLUSION: Perioperative treatment with a single bolus of methadone improves postoperative pain control for patients undergoing complex spine surgery.


Ruptured L4-5 10/91 - diskectomy 2/92. Fibro started 4/92. Cervical myelopathy 12/07 - laminectomy C4-7 3/08. B12 peripheral neuropathy 6/10.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Stevie Quote  Post ReplyReply Direct Link To This Post Posted: Aug/10/2011 at 9:10pm
Wolf,

Here is my take on this and I would ask anyone reading here to please let us know if you know more about this study.

It would appear to me that they used Sufentanil, which is a powerful opioid analgesic, 5-10 times more potent than fentanyl during surgery, but a drug that is short acting vs. Methadone, which is a drug that has a half life of anywhere between 15-60 hours.  So, the Methadone is still working and giving pain relief when the patient awakens from surgery.

From personal experience, I remember well waking up in the recovery room in incredible pain after long and involved spinal fusions and having to play "catch up" where pain control was concerned.  I do NOT know what was used during my surgeries, but as these were done quite some time ago, I am sure that it was not Methadone.  

As this is a new study and we know very little about it, it is something to definitely ask your Anesthesiologist about.  It makes good sense that a longer acting opiod during the procedure would be far beneficial for post-op pain control.  Everyone---keep looking at this and let us know what you find out.

Please donate to help Chronicpainsite.com continue to help others.

My journey with chronic pain began over 30 years ago, while as a young nurse working spinal rehab, I injured my back lifting a patient. I am now fused from L2-S1. I have multiple thoracic and cervical issues. I'm a retired RN/PA and I know and understand the frustrations on both ends of the treatment spectrum of dealing with CP. It's been my goal since 2008, when we started this site, to reach out and help as many people in pain as possible. We will continue the fight as long as we can. Please, if you can help us continue to help you and others, donate. Thank you.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Jeff Quote  Post ReplyReply Direct Link To This Post Posted: Oct/14/2013 at 11:13pm
Well you can bet your britches I'll be asking about this idea during my pre-op appointment for cervical laminectomy and fusion.  THANK YOU!!!!

During a bad period with my back over a decade ago, at one point I was put on methadone, and I was so numb it scared me because I couldn't feel my heart beating or my lungs moving.

Best idea EVER.

Thanks Stevie ClapClapClap
Ankylosing spondylitis & osteoporosis -> compression fractures -> facet & ligamentum flavum hypertrophy-> stenosis -> spinal cord & nerve root compression -> cervical myelopathy & radiculopathy -> bruise & deformation of my spinal cord -> incomplete spinal cord injury -> postlaminectomy syndrome of cervical region. Cervical laminectomy & fusion decompressed my cord but I now have severe chronic pain. Pain meds = Oxycontin, Percocet, Lyrica, Soma, Cymbalta, Voltaren Gel, & Ketamine pain cream. 11 surgeries including 5 orthopedic & 1 neurosurgery.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Stevie Quote  Post ReplyReply Direct Link To This Post Posted: Oct/15/2013 at 8:13am
Thank you for going back into the archives and finding this from a couple of years ago.  Thing is, I haven't heard anymore about this, and wonder if it's something that is still being done, or phased out.   It may be worth a call to the U of Virginia and ask to speak to someone in the department of Anesthesiology to see if that study is ongoing and/or are they still using this?

Please donate to help Chronicpainsite.com continue to help others.

My journey with chronic pain began over 30 years ago, while as a young nurse working spinal rehab, I injured my back lifting a patient. I am now fused from L2-S1. I have multiple thoracic and cervical issues. I'm a retired RN/PA and I know and understand the frustrations on both ends of the treatment spectrum of dealing with CP. It's been my goal since 2008, when we started this site, to reach out and help as many people in pain as possible. We will continue the fight as long as we can. Please, if you can help us continue to help you and others, donate. Thank you.
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