Newly Published
Clinical Focus Review  |   May 2019
Intraoperative Methadone in Surgical Patients: A Review of Clinical Investigations
Author Notes
  • From the Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, Illinois.
  • From the Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, Illinois.
  • Submitted for publication October 5, 2018. Accepted for publication March 13, 2019.
    Submitted for publication October 5, 2018. Accepted for publication March 13, 2019.×
  • Correspondence: Address correspondence to Dr. Murphy: NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, Illinois 60201. dgmurphy2@yahoo.com. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Pain Medicine / Respiratory System / Clinical Focus Review
Clinical Focus Review   |   May 2019
Intraoperative Methadone in Surgical Patients: A Review of Clinical Investigations
Anesthesiology Newly Published on May 7, 2019. doi:10.1097/ALN.0000000000002755
Anesthesiology Newly Published on May 7, 2019. doi:10.1097/ALN.0000000000002755
The relief of postoperative pain continues to pose a primary therapeutic challenge for clinicians. Despite the development and implementation of novel analgesic strategies over the past several decades, more than 50% of patients experience moderate-to-severe pain, even after “minor” surgical procedures.1–3  Traditionally, shorter-acting opioids like morphine or hydromorphone have been administered as intermittent intravenous boluses to provide postoperative analgesia. However, this approach can produce widely fluctuating blood opioid concentrations, resulting in clinical responses that can range from inadequate pain relief to profound sedation and respiratory depression. Postoperative pain may be more effectively managed with patient-controlled analgesia devices, but this approach requires complex programed infusion systems, patient cooperation and education, and can also result in significant variability in drug concentrations (a bolus is administered when the patient experiences pain). The use of regional anesthetic techniques can provide high-quality analgesia but is not possible in all patients and may not provide complete pain relief.