Methadone and ketamine combo effective for pain control after spinal surgery: Study

USA: Perioperative administration of a combination of methadone and ketamine improves postoperative analgesia and reduces opioid need in patients who have undergone spine surgery, finds a recent study in the journal Anesthesiology. The combo could be considered in patients recovering from spine surgery.

Patients undergoing spinal fusion surgery frequently report severe postoperative pain despite application of multimodal pain management strategies. Methadone and ketamine, N-methyl-d-aspartate receptor antagonists, have been shown to facilitate postoperative pain control. The study by Glenn S. Murphy, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and colleagues, therefore, tested the primary hypothesis that patients recovering from spinal fusion surgery who are given ketamine and methadone use less hydromorphone on the first postoperative day than those give methadone alone.

For this purpose, the researchers conducted a randomized, double-blind, placebo-controlled trial that included 130 spinal surgery patients. They were randomized to receive either methadone at 0.2 mg/kg (ideal body weight) intraoperatively and a 5% dextrose in water infusion for 48 h postoperatively (methadone group) or 0.2 mg/kg methadone intraoperatively and a ketamine infusion (0.3 mg · kg−1 · h−1 infusion [no bolus] intraoperatively and then 0.1 mg · kg−1 · h−1 for next 48 h [both medications dosed at ideal body weight]; methadone/ketamine group).