Kristian D. Friesgaard , Lone D. Brix , Christina B. Kristensen , Omar Rian , Lone Nikolajsen
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Secondary outcomes included pain intensity at rest and during coughing, patient satisfaction, postoperative nausea and vomiting, and adverse events up to 72 h after completion of surgery.</p></div><div><h3>Results</h3><p>The postoperative median opioid consumption was reduced in the methadone group compared with the morphine group at 6 h (35.5 [0–61] mg <em>vs</em> 48 [31–74.5] mg; <em>P</em>=0.01) and 24 h (42 [10–67] mg <em>vs</em> 54.5 [31–83] mg; <em>P</em>=0.03). On arrival at the PACU, pain at rest was significantly lower in patients receiving methadone (numeric rating scale: 3 [2–5] <em>vs</em> 5 [3–6]), whereas pain scores at rest and coughing were not significantly different throughout the rest of the observation period. No differences in other secondary outcomes were found.</p></div><div><h3>Conclusions</h3><p>In this randomised, blinded, controlled trial, opioid consumption was reduced during the first 24 postoperative hours in patients receiving methadone without causing an increase in adverse events. The difference observed might be considered as small and of limited clinical relevance.</p></div><div><h3>Clinical trial registration</h3><p>NCT03908060; EudraCT no. 2018-004351-20.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10457492/pdf/","citationCount":"0","resultStr":"{\"title\":\"Clinical effectiveness and safety of intraoperative methadone in patients undergoing laparoscopic hysterectomy: a randomised, blinded clinical trial\",\"authors\":\"Kristian D. Friesgaard , Lone D. Brix , Christina B. Kristensen , Omar Rian , Lone Nikolajsen\",\"doi\":\"10.1016/j.bjao.2023.100219\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Laparoscopic hysterectomy is often carried out as day-stay surgery. Minimising postoperative pain is therefore of utmost importance to ensure timely discharge from hospital. Methadone has several desirable pharmacological features, including a long elimination half-life. Therefore, a single intraoperative dose could provide long-lasting pain relief.</p></div><div><h3>Methods</h3><p>Patients scheduled to undergo laparoscopic hysterectomy were randomly allocated to receive methadone (0.2 mg kg<sup>−1</sup>) or morphine (0.2 mg kg<sup>−1</sup>) intraoperatively, 60 min before tracheal extubation. Primary outcomes were opioid consumption (oral morphine equivalents in milligrams) at 6 and 24 h. Secondary outcomes included pain intensity at rest and during coughing, patient satisfaction, postoperative nausea and vomiting, and adverse events up to 72 h after completion of surgery.</p></div><div><h3>Results</h3><p>The postoperative median opioid consumption was reduced in the methadone group compared with the morphine group at 6 h (35.5 [0–61] mg <em>vs</em> 48 [31–74.5] mg; <em>P</em>=0.01) and 24 h (42 [10–67] mg <em>vs</em> 54.5 [31–83] mg; <em>P</em>=0.03). On arrival at the PACU, pain at rest was significantly lower in patients receiving methadone (numeric rating scale: 3 [2–5] <em>vs</em> 5 [3–6]), whereas pain scores at rest and coughing were not significantly different throughout the rest of the observation period. No differences in other secondary outcomes were found.</p></div><div><h3>Conclusions</h3><p>In this randomised, blinded, controlled trial, opioid consumption was reduced during the first 24 postoperative hours in patients receiving methadone without causing an increase in adverse events. The difference observed might be considered as small and of limited clinical relevance.</p></div><div><h3>Clinical trial registration</h3><p>NCT03908060; EudraCT no. 2018-004351-20.</p></div>\",\"PeriodicalId\":72418,\"journal\":{\"name\":\"BJA open\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10457492/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BJA open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2772609623000989\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BJA open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772609623000989","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景腹腔镜子宫切除术通常作为日间手术进行。因此,尽量减少术后疼痛对于确保及时出院至关重要。美沙酮有几个令人满意的药理学特征,包括较长的消除半衰期。因此,单次术中剂量可以提供持久的疼痛缓解。方法随机选择行腹腔镜子宫切除术的患者,在拔管前60 min,术中给予美沙酮(0.2 mg kg−1)或吗啡(0.2 mg kg−1)。主要结局是6和24小时的阿片类药物消耗(口服吗啡当量毫克)。次要结局包括休息和咳嗽时的疼痛强度、患者满意度、术后恶心和呕吐以及手术完成后72小时的不良事件。结果美沙酮组术后6 h阿片类药物中位消耗较吗啡组降低(35.5 [0-61]mg vs 48 [31-74.5] mg;P=0.01)和24 h (42 [10-67] mg vs 54.5 [31-83] mg;P = 0.03)。到达PACU时,接受美沙酮治疗的患者静息疼痛明显降低(数值评定量表:3 [2-5]vs 5[3 - 6]),而在整个观察期内,静息疼痛和咳嗽评分无显著差异。其他次要结局无差异。结论:在这项随机、盲法、对照试验中,接受美沙酮治疗的患者术后24小时内阿片类药物的使用减少,且未引起不良事件的增加。观察到的差异可能被认为很小,临床相关性有限。临床试验注册nct03908060;EudraCT没有。2018-004351-20。
Clinical effectiveness and safety of intraoperative methadone in patients undergoing laparoscopic hysterectomy: a randomised, blinded clinical trial
Background
Laparoscopic hysterectomy is often carried out as day-stay surgery. Minimising postoperative pain is therefore of utmost importance to ensure timely discharge from hospital. Methadone has several desirable pharmacological features, including a long elimination half-life. Therefore, a single intraoperative dose could provide long-lasting pain relief.
Methods
Patients scheduled to undergo laparoscopic hysterectomy were randomly allocated to receive methadone (0.2 mg kg−1) or morphine (0.2 mg kg−1) intraoperatively, 60 min before tracheal extubation. Primary outcomes were opioid consumption (oral morphine equivalents in milligrams) at 6 and 24 h. Secondary outcomes included pain intensity at rest and during coughing, patient satisfaction, postoperative nausea and vomiting, and adverse events up to 72 h after completion of surgery.
Results
The postoperative median opioid consumption was reduced in the methadone group compared with the morphine group at 6 h (35.5 [0–61] mg vs 48 [31–74.5] mg; P=0.01) and 24 h (42 [10–67] mg vs 54.5 [31–83] mg; P=0.03). On arrival at the PACU, pain at rest was significantly lower in patients receiving methadone (numeric rating scale: 3 [2–5] vs 5 [3–6]), whereas pain scores at rest and coughing were not significantly different throughout the rest of the observation period. No differences in other secondary outcomes were found.
Conclusions
In this randomised, blinded, controlled trial, opioid consumption was reduced during the first 24 postoperative hours in patients receiving methadone without causing an increase in adverse events. The difference observed might be considered as small and of limited clinical relevance.