One of the latest clinical studies found that intraoperative use of methadone could significantly reduce the need for post-tonsillectomy opioid use in children. Moreover, the study found that methadone was more effective than fentanyl in reducing the requirement for opioids.
In the US, more than half a million tonsillectomies are performed each year. Many of these patients require prolonged use of opioids for pain control in the post-operative phase. Moreover, there are no strict guidelines or consensus regarding opioid use in these patients. Hence, researchers carried out a study to understand how to reduce the use of opioids in these patients.
They were especially interested in exploring the role of methadone as an opioid-sparing therapy. Methadone is an opioid with an excellent safety profile. This drug is also used to manage opioid use disorder. However, It can also help reduce pain. What is good about methadone is its long half-life of 1 to 2 days. It means that a single dose of this drug can provide prolonged pain relief. Researchers also wanted to see how methadone works compared to short-duration opioids like fentanyl, which has a half-life of a few hours only.
In this new clinical study, researchers wanted to check the hypothesis that using methadone will not just provide good pain relief but it will also reduce the need for opioid use. They also wanted to check if methadone was superior to short-action opioids like fentanyl.
This study was done in children 3 to 17 years old undergoing tonsillectomy. They were either given methadone intravenously (0.1 mg/kg or 0.15 mg/kg) or short-acting opioid fentanyl. They compared the effectiveness of perioperative use of these opioids with control subjects. They also assessed how well these approaches worked for pain control.
In the study, researchers found that intraoperative use of methadone could reduce the need for oral morphine in the post-operative phase significantly. Further, they also found that a methadone dosage of 0.15 mg/kg was most effective for pain control and reducing the need for oral opioids in the post-operative phase. Methadone was much more effective compared to fentanyl in reducing the need for opioids after tonsillectomy.
Methadone was as good as fentanyl for pain control, and it was well-tolerated. It could reduce the need for opioids. Thus, a single dose of methadone used intraoperatively was better than multiple dosages of fentanyl.
There could be many reasons why methadone was superior. But, perhaps one of the most significant reasons for these findings is that methadone has an exceptionally long half-life. It means that even a single dose of methadone can provide prolonged pain relief, something not characteristic of fentanyl.
Of course, this was still an exploratory study. Nonetheless, this study found that methadone was significantly better than fentanyl, and it could reduce opioid use in the post-operative phase in a pediatric population.
In recent years, there has been increased interest in methadone’s role in pain management. It appears to be good for controlling various pain and is also among the safer opioids.
Tonsillectomy is among the most painful surgeries in children, and these findings provide hope for better pain control.
At present, methadone isn’t routinely used for pain control in pediatrics. It is uncommon to use methadone to control other kinds of pain. There is a need for more extensive trials to understand the role of this opioid in pain management.
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
