Intraoperative administration of methadone reduced postoperative pain and opioid consumption following cadaveric renal transplantation: a randomized controlled trial


Objective: In this randomized clinical trial study, the impact of prophylactic administration of methadone during surgery on postoperative pain and analgesic requirement following cadaveric renal transplantation was assessed. Methods: Ninety patients were randomized to receive either methadone 0.15 mg/kg or 0.15mg/kg morphine after tracheal intubation. Both groups were treated with acetaminophen 1 gr before extubation. Protocol of anesthesia was the same in both groups and the anesthetist was blinded to the study groups. The primary outcome was defined as total opioid consumption during recovery and first day after surgery. Secondary outcomes were pain scores and level of patients’ sedation during the recovery period and first postoperative day as well as opioid-related complications. Results: Data of eighty-five eligible patients were analyzed. The mean pain and sedation scores were lower in the methadone group compared to the morphine group during recovery and the first 24 hours after surgery. The time of first rescue analgesic requirement was later in the methadone group (10.4 vs 6.3 hours). Also, postoperative morphine consumption was significantly less in the methadone group compared to patients receiving morphine (3.5 vs. 6.9 mg; P < 0.001). Conclusion: Intraoperative administration of methadone decreased postoperative pain scores, reduced opioid consumption after surgery and improved level of sedation during the first 24 hours after surgery.

1. Meissner W, Zaslansky R. A survey of postoperative pain treatments and unmet needs. Best Pract Res Clin Anaesthesiol. 2019;33(3):269-86.
2. Khajavi MR, Nadjafi A, Moharari RS, Imani F, Rahimi I. Attitudes of anesthesiology residents and faculty members towards pain management. Middle East J Anaesthesiol. 2012;21(4):521-8.
3. Khalighi E, Soufinia A, Solaimanizadeh L, Borji M, Tarjoman A, Soltany B, et al. Knowledge, attitudes and barriers pain management by nurses in Iran: A systematic review. Anaesth Pain Intensive Care. 2019;23(4):360-9.
4. Khan ZH, Karvandian K, Maghsoudloo M, Albareh H. The Role of Opioids and Non-Opioids in Postoperative Pain Relief; A Narrative Review. Arch Anesth Crit Care. 2018;4(1):430-435.
5. Roozekrans M, van der Schrier R, Aarts L, Sarton E, van Velzen M, Niesters M, Dahan A, Olofsen E. Benefit versus severe side effects of opioid analgesia: novel utility functions of probability of analgesia and respiratory depression. Anesthesiology. 2018;128(5):932-42.
6. Schwab ME, Braun HJ, Ascher NL, Hirose R. Implementing an opioid reduction protocol in renal transplant recipients. Am J Surg. 2020;220(5):1284-9.
7. Murphy GS, Szokol JW. Intraoperative methadone in surgical patients: a review of clinical investigations. Anesthesiology. 2019;131(3):678-92.
8. Lugo RA, Satterfield KL, Kern SE. Pharmacokinetics of methadone. J Pain Palliat Care Pharmacother. 2005;19(4):13-24
9. Machado FC, de Araújo Palmeira CC, Torres JN, Vieira JE, Ashmawi HA. Intraoperative use of methadone improves control of postoperative pain in morbidly obese patients: a randomized controlled study. J Pain Res. 2018;11:2123-29.
10. Machado FC, Vieira JE, Flávia A, Ashmawi HA. Intraoperative methadone reduces pain and opioid consumption in acute postoperative pain: a systematic review and meta-analysis. Anesth Analg. 2019;129(6):1723-32.
11. Etezadi F, Farzizadeh M, Sharifinia HR, Alimohammadi M, Khajavi MR. The Effect of Intraoperative Ketamine and Magnesium Sulfate on Acute Pain and Opioid Consumption After Spine Surgery. Acta Med Iran. 2020.58(5):221-4.
12. Pourfakhr P, Aghabagheri M, Zabihi Mahmoudabadi H, Najjari K, Talebpour M, Khajavi MR. Prophylactic Administration of Diphenhydramine/Acetaminophen and Ondansetron Reduced Postoperative Nausea and Vomiting and Pain Following Laparoscopic Sleeve Gastrectomy: a Randomized Controlled Trial. Obes Surg. 2021;31(10):4371-5.
13. Tan JH, Bhatia K, Sharma V, Swamy M, van Dellen D, Dhanda R, et al. Enhanced recovery after surgery recommendations for renal transplantation: guidelines. Br J Surg. 2022;110(1):57-9.
14. Lentine KL, Lam NN, Naik AS, Axelrod DA, Zhang Z, Dharnidharka VR, et al. Prescription opioid use before and after kidney transplant: implications for posttransplant outcomes. Am J transplant. 2018;18(12):2987-99.
15. Vondracek SF, Teitelbaum I, Kiser TH. Principles of kidney pharmacotherapy for the nephrologist: core curriculum 2021. Am J Kidney Dis. 2021;78(3):442-58.
16. Sukcharoen K, Jeffery Z, Ratcliffe L, Miller J, Mulgrew C. Prescribing analgesia for patients with impaired renal function. Br J Hosp Med. 2018;79(5):C74-7.
17. Kreutzwiser D, Tawfic QA. Methadone for pain management: a pharmacotherapeutic review. CNS Drugs. 2020;34(8):827-39.
18. D'Souza RS, Gurrieri C, Johnson RL, Warner N, Wittwer E. Intraoperative methadone administration and postoperative pain control: a systematic review and meta-analysis. Pain. 2020;161(2):237-43.
19. Mercadante S, David F, Villari P, Spedale VM, Casuccio A. Methadone versus morphine for postoperative pain in patients undergoing surgery for gynecological cancer: A randomized controlled clinical trial. J Clin Anesth. 2020;61:109627.
20. Lobova VA, Roll JM, Roll ML. Intraoperative Methadone Use in Cardiac Surgery: A Systematic Review. Pain Med. 2021;22(12):2827-34.
21. Barnett AM, Machovec KA, Ames WA, Homi HM, Turi JL, Koo J, et al. The effect of intraoperative methadone during pediatric cardiac surgery on postoperative opioid requirements. Pediatr Anesth. 2020;30(7):773-9.
22. Seifter JL, Samuels MA. Uremic encephalopathy and other brain disorders associated with renal failure. Semin Neurol. 2011;31(2):139-43.
IssueVol 7 No 1 (2023): Winter (February) QRcode
SectionOriginal article
DOI 10.18502/fem.v7i1.11696
Kidney Transplantation Methadone Morphine Postoperative Pain Pain Management

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Khajavi MR, Kharazmi S, Dialameh H, Biderafsh A. Intraoperative administration of methadone reduced postoperative pain and opioid consumption following cadaveric renal transplantation: a randomized controlled trial. Front Emerg Med. 2023;7(1):e6.


Download data is not yet available.