• Buckner PettySkye ASADepartment of Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ., Gwendolyn Raynor, Ricardo Verdiner, Elizabeth H Stephens, Osezele Oboh, Tiffany Williams, Linda Shore-Lesserson, and Adam J Milam.
• Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ.
• J. Cardiothorac. Vasc. Anesth. 2024 Nov 22.

ObjectivesTo evaluate whether the addition of ketamine to intraoperative methadone is associated with superior postoperative pain management and decreased opioid consumption compared with methadone alone in cardiac surgery patients.DesignA retrospective cohort study.SettingA large academic medical system comprising four sites.ParticipantsA total of 6,856 patients who underwent cardiac surgery with cardiopulmonary bypass and received intraoperative methadone between 2018 and 2023 were included. Patients were divided into two groups: those who received both methadone and ketamine (Group M+K; n = 5,696) and those who received methadone alone (Group M; n = 1,160).InterventionsIntraoperative administration of methadone with or without ketamine. Some patients also received additional opioids such as hydromorphone and fentanyl.Measurements And Main ResultsThe primary outcomes were daily total oral morphine equivalents (OMEs) until postoperative day (POD) 7 and the time to first postoperative opioid administration. The secondary outcome was daily postoperative pain scores until POD 7. Exploratory outcomes included delirium and intensive care unit length of stay. The median time to first postoperative opioid administration was longer in Group M+K (7.2 hours) compared with Group M (5.0 hours) (hazard ratio = 0.88, 95% confidence interval: [0.82, 0.95]). Total OMEs were significantly lower in Group M+K on POD 0 (ß = -2.24; 95% confidence interval: [-3.2, -1.3]), with no significant differences beyond POD 0. No significant differences were found in pain scores or exploratory outcomes.ConclusionsAdding ketamine to methadone prolonged the time to first opioid consumption postoperatively but showed no benefits beyond POD 0. Future studies should consider protocolized dosing to optimize pain control.Copyright © 2024 Elsevier Inc. All rights reserved.

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