Intraoperative methadone lowers post-tonsillectomy opioid use in children, a new study found. Intraoperative means given during surgery. The drug could significantly cut the need for opioids after surgery. The study also found that methadone beat fentanyl at lowering the need for opioids.
In the US, doctors do more than half a million tonsillectomies each year. Many of these patients need opioids for a long time to control pain after surgery. There are no strict rules or agreement on opioid use in these patients. So researchers ran a study to learn how to cut opioid use in this group.
They mainly wanted to test methadone as a way to spare opioids later. Methadone is an opioid with an excellent safety record. Doctors also use it to treat opioid use disorder. But it can also ease pain. The good thing about methadone is its long half-life of 1 to 2 days. Half-life is the time the body takes to clear half the drug. So one dose can give long-lasting pain relief. Researchers also wanted to compare methadone with short-acting opioids like fentanyl. Fentanyl has a half-life of only a few hours.
In this new study, researchers tested one idea. Would methadone give good pain relief and also cut the need for more opioids? They also wanted to see if methadone beat short-acting opioids like fentanyl.
The study included children 3 to 17 years old having their tonsils out. They got either methadone through a vein (0.1 mg/kg or 0.15 mg/kg) or the short-acting opioid fentanyl. Researchers compared these drugs, given around the time of surgery, with control subjects. They also measured how well each approach controlled pain.
Researchers found that methadone given during surgery could significantly cut the need for oral morphine afterward. A methadone dose of 0.15 mg/kg worked best. It gave the best pain control and the biggest drop in oral opioids after surgery. Methadone was far better than fentanyl at cutting the need for opioids after tonsillectomy.
Methadone controlled pain as well as fentanyl did, and children handled it well. It could cut the need for opioids. So one dose of methadone during surgery beat several doses of fentanyl.
Methadone may have won for many reasons. But one big reason is likely its very long half-life. Even one dose of methadone can give long-lasting pain relief. Fentanyl cannot do that.
Of course, this was still an early, exploratory study. Even so, it found methadone was significantly better than fentanyl. It also could cut opioid use after surgery in children.
In recent years, interest in methadone for pain has grown. It seems to control many kinds of pain well. It is also one of the safer opioids.
Tonsillectomy is one of the most painful surgeries in children. These findings offer hope for better pain control.
Right now, doctors do not use methadone for pain control in children as a routine. It is also rare to use methadone for other kinds of pain. Larger trials must still define this opioid’s role in pain care.
Frequently asked questions
Why is methadone used for tonsillectomy pain in children?
Methadone has a long half-life of 1 to 2 days. So one dose given during surgery keeps working long after the child wakes up. Fentanyl lasts only a few hours. A randomized double-blind trial studied children 3 to 17 years old. One intraoperative dose of methadone significantly cut the need for oral morphine after tonsillectomy.
Is methadone better than fentanyl after a tonsillectomy?
In this trial, yes. Methadone controlled pain as well as fentanyl, and children handled it well. It also cut the need for opioids after surgery much more. One dose of methadone during the operation beat several doses of fentanyl. The likely reason is methadone’s long half-life. It gives long-lasting pain relief.
What dose of methadone was used in the children’s tonsillectomy study?
Children got methadone through a vein at either 0.1 mg/kg or 0.15 mg/kg. Researchers compared those groups with children given fentanyl. The 0.15 mg/kg dose worked best. It gave the best pain control and the biggest drop in oral opioids after surgery.
Is methadone commonly used for children’s pain?
Not yet. Doctors do not use methadone for pain control in children as a routine. It is also rare for other kinds of pain. This was an exploratory study. Larger trials must still define its role. Still, the results offer hope. Tonsil surgery is one of the most painful surgeries children face.
Source:
Einhorn, L. M., Hoang, J., La, J. O., & Kharasch, E. D. (2024). Single-dose Intraoperative Methadone for Pain Management in Pediatric Tonsillectomy: A Randomized Double-blind Clinical Trial. Anesthesiology, 141(3), 463–474. https://doi.org/10.1097/ALN.0000000000005031
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