Methadone and Ketamine are effective for pain control after
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Perioperative administration of methadone and ketamine improves postoperative analgesia and reduces opioid need in patients who have undergone spinal surgery, finds a recent study in the journal Anesthesiology. The combo could be considered in patients recovering from spine surgery.

This study tested the primary hypothesis that patients recovering from spinal fusion surgery who are given ketamine and methadone use less hydromorphone on the first postoperative day than those give methadone alone.

In this randomized, double-blind, placebo-controlled trial, 130 spinal surgery patients were randomized to receive either methadone at 0.2 mg/kg intraoperatively and a 5% dextrose in water infusion for 48 h postoperatively (methadone group) or 0.2 mg/kg methadone intraoperatively and a ketamine infusion (0.3 mg · kg−1 · h−1 infusion intraoperatively and then 0.1 mg · kg−1 · h−1 for next 48 h; methadone/ketamine group). Anesthetic care was standardized in all patients. Intravenous hydromorphone use on postoperative day 1 was the primary outcome. Pain scores, intravenous and oral opioid requirements, and patient satisfaction with pain management were assessed for the first 3 postoperative days.

--Median intravenous hydromorphone requirements were lower in the methadone/ketamine group on postoperative day 1 and postoperative day 2.

--In addition, fewer oral opioid tablets were needed in the methadone/ketamine group on postoperative day 1 and postoperative day 3.

--Pain scores at rest, with coughing, and with the movement were lower in the methadone/ketamine group at 23 of the 24 assessment times. Patient-reported satisfaction scores were high in both study groups.

Conclusively, postoperative analgesia was enhanced by the combination of methadone and ketamine, which act on both N-methyl-d-aspartate and μ-opioid receptors.

Source: https://doi.org/10.1097/ALN.0000000000003743
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