• Karen Singh, Siny Tsang, Jessica Zvara, Joshua Roach, Susan Walters, John McNeil, Scott Jossart, Amir Abdel-Malek, Kenan Yount, and Michael Mazzeffi.
• Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA.
• J. Cardiothorac. Vasc. Anesth. 2024 Aug 1; 38 (8): 169917061699-1706.

ObjectiveTo explore the association between intraoperative methadone use, postoperative pain, and opioid consumption after coronary artery bypass grafting (CABG) surgery.DesignRetrospective cohort study.SettingSingle academic medical center.ParticipantsPatients undergoing isolated CABG over a 5-year period.InterventionsNone.Measurements And Main ResultsDemographic data, comorbidities, and intraoperative anesthetic medications were recorded. Primary study outcomes were average and maximum pain scores and morphine milligram equivalent consumption on the first 2 postoperative days (PODs). Linear mixed-effects regression models were used to examine the effect of intraoperative methadone use on study outcomes. Among 1,338 patients, 78.6% received intraoperative methadone (0.2 mg/kg). Patients who did not receive methadone had higher average (estimated [Est], 0.48; 95% confidence interval [CI], 0.22-0.73; p < 0.001) and maximum postoperative (Est, 0.49; 95% CI, 0.23-0.75; p < 0.001) pain scores over PODs 0 to 2. For postoperative opioid consumption, there was a significant intraoperative methadone use-time interaction effect on postoperative opioid use (odds ratio [OR], 2.21; 95% CI, 1.74-2.80; p < 0.001). Across PODs 0 to 2, patients who received intraoperative methadone had a faster decline in postoperative opioid use than those who did not receive intraoperative methadone. Patients who did not receive intraoperative methadone were extubated slightly faster (OR, 0.82; 95% CI, 0.72-0.93; p < 0.01).ConclusionsOur data suggest that the use of intraoperative methadone is safe, reduces postoperative pain, and expedites weaning from postoperative opioids after CABG surgery.Copyright © 2024 Elsevier Inc. All rights reserved.

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