• Joshua D Robinson, Thomas J Caruso, May Wu, Zachary I Kleiman, and David M Kwiatkowski.
• Pharmacy Department, Lucile Packard Children's Hospital Stanford, Palo Alto, CA; Department of Pharmaceutical Services, University of California San Francisco Medical Center, San Francisco, CA. Electronic address: Robinson.josh.d@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2020 Feb 1; 34 (2): 335-341.

ObjectiveTo determine if there is an association of intraoperative methadone use and total perioperative opioid exposure in patients undergoing congenital heart surgeries.DesignRetrospective, case-match cohort study.SettingSingle center quaternary care teaching hospital.ParticipantsSeventy-four patients with congenital heart disease (CHD) undergoing surgical repair or palliative surgery.InterventionThirty-seven patients undergoing CHD surgeries receiving intraoperative methadone were matched to 37 patients based upon age and procedure who did not receive intraoperative methadone. The primary study outcome was to evaluate total opioid use in intravenous milligrams of morphine equivalents per kilogram (mg ME/kg) within the first 36-hours postoperatively. Mann-Whitney U test was used to compare total opioid exposure.Measurements And Main ResultsThe total opioid use was compared between groups. The methadone cohort required less opioids intraoperatively, in the first 12 hours postoperatively, and during the first 36 hours postoperatively (2.51 v 4.39 mg ME/kg, p < 0.001; 0.43 v 1.28 mg ME/kg, p = 0.001; and 0.83 v 1.91 mg ME/kg, p < 0.001) compared with the matched control cohort. There were no differences in clinical outcomes or adverse events. A dose-dependent reduction in opioid consumption in high- versus low-dose groups also was not observed.ConclusionIntraoperative methadone use was associated with a decrease in perioperative opioid exposure in patients undergoing congenital heart surgery and was not associated with adverse events or prolonged durations of mechanical ventilation or ICU stay.Copyright © 2019 Elsevier Inc. All rights reserved.

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