Background:
The use of intraoperative methadone has received considerable attention due to reports
of reduced postoperative pain and opioid consumption without increased risk of opioid-related
side effects. The purpose of this study was to compare perioperative opioid requirements
in patients who received intraoperative methadone to those who did not receive intraoperative
methadone following free flap breast reconstruction (FFBR).
Methods:
A retrospective review of patients who underwent FFBR from July 2023 to August 2024
was performed. Patients were stratified into an intraoperative methadone and non-intraoperative
methadone cohort. Patient demographics, operative characteristics, hospital length
of stay (LOS), and perioperative opioid consumption per patient were collected. The
primary outcome was daily postoperative opioid requirements, recorded in morphine
milligram equivalents (MME).
Results:
A total of 112 patients who underwent FFBR breast reconstruction were identified,
54 in the intraoperative methadone cohort and 58 in the non-intraoperative methadone
cohort. Mean opioid consumption was significantly less for the methadone cohort intraoperatively
(23.7±13.7 MME vs. 44.5±18.8 MME, p<0.01), on postoperative day (POD) 1 (29.04±28.9
MME vs. 44.4±37.9 MME, p=0.04), POD-2 (22.9±25.7 MME vs. 38.7±38.2 MME, p=0.04), and
overall throughout hospitalization compared to the non-intraoperative methadone patients
(87.4±87.1 vs. 139.1±121.2; p=0.03).
Conclusion:
Intraoperative methadone significantly reduces inpatient opioid use after undergoing
autologous breast reconstruction on POD-1, POD2, and overall throughout hospitalization.
Our findings support the need for well-designed prospective trials to further assess
the effectiveness of intraoperative methadone in managing perioperative pain and reducing
opioid use during FFBR.
