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Intra‐operative methadone effect on quality of recovery compared with morphine following laparoscopic gastroplasty: a randomised controlled trial
Author(s) -
Pontes J. P. J.,
Braz F. R.,
Módolo N. S. P.,
Mattar L. A.,
Sousa J. A. G.,
Navarro e Lima L. H.
Publication year - 2021
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/anae.15173
Subject(s) - medicine , methadone , morphine , anesthesia , nausea , vomiting , incidence (geometry) , postoperative nausea and vomiting , morning , surgery , physics , optics
Summary The effect of intra‐operative intravenous methadone on quality of postoperative recovery was compared with morphine after laparoscopic gastroplasty. We included 137 adult patients with a body mass index > 35 kg.m −2 who underwent bariatric surgery. Patients were allocated at random to receive either intra‐operative methadone (n = 69) or morphine (n = 68). All patients received the same postoperative care and analgesia. The primary outcome of postoperative quality of recovery was assessed using the Quality of Recovery‐40 questionnaire total score 24 h after surgery. Secondary outcomes were assessed in the post‐anaesthesia care unit the night of the day of surgery (T1), in the morning after surgery (T2); and at night on the day following surgery (T3). The median (IQR [range]) total Quality of Recovery‐40 questionnaire score of 194 (190–197 [165–200]) was higher (p < 0.0001) in the methadone group compared with the score of 181 (174–185.5 [121–200]) in the morphine group. In the post‐anaesthesia care unit, the pain burden; incidence of nausea and vomiting; rescue morphine dose; and time to discharge, were significantly lower in the methadone group. On the ward, the methadone group had a lower: incidence of rescue morphine requests at T1 (5.8 vs. 54.4%, p < 0.0001) and T2 (0 vs. 20.1%, p < 0.0001); and incidence of nausea (21.7 vs. 41.2%, p = 0.014), compared with the morphine group. We conclude that intra‐operative intravenous methadone improved quality of recovery in patients who underwent laparoscopic gastroplasty, compared with intra‐operative morphine. Methadone also reduced postoperative pain, postoperative opioid consumption and the incidence of opioid‐related adverse events.