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Canadian Journal of Anesthesia

, Volume 52, Issue 5, pp 513–523 | Cite as

Review article: Perioperative pain management of patients on methadone therapy

  • Philip W. H. PengEmail author
  • Paul S. Tumber
  • Douglas Gourlay
Regional anesthesia and pain

Abstract

Purpose

Methadone, an opioid traditionally associated with the management of opioid addictive disorders, has been prescribed increasingly as an analgesic for the management of various chronic pain conditions. Despite the increasing popularity of methadone, most anesthesiologists are not familiar with its complex pharmacology. The purpose of this article is to review the pharmacology of methadone and to suggest a management algorithm for the perioperative care of methadone patients.

Source

A Medline search was performed to obtain the published literature on the pharmacology of methadone and its use perioperatively.

Principal findings

The complexity of methadone’s pharmacology is characterized by a high inter-individual variability, a potential for interaction with other medications, and a long elimination half-life. The postoperative management of methadone patients may be difficult as they are often ‘opioid-tolerant’ but may be ‘pain-intolerant’. For those patients who are taking part in methadone-maintenance programs, there is a potential for the problematic use of opioids or other substances. The management plan for patients taking methadone may differ depending on the type of surgery and the associated perioperative differences in fasting status and gastrointestinal function. In consideration of all the factors listed above, a management algorithm is outlined for the perioperative care of methadone patients.

Conclusion

Methadone is an opioid with complex properties, and a patient that is taking methadone can represent a unique challenge to the anesthesiologist. A good understanding of the pharmacology of methadone and of the type of patients on this medication will help to improve their perioperative care.

Keywords

Morphine Cancer Pain Methadone Maintenance Treatment Methadone Maintenance Therapy Opioid Addiction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Exposé de synthèse : Traitement de la douleur périopératoire chez les patients sous thérapie à la méthadone

Résumé

Objectif

La méthadone, opiacé habituellement associé au traitement des dépendances aux opiacés, est prescrite de plus en plus comme analgésique pour diverses douleurs chroniques. Malgré sa popularité croissante, la plupart des anesthésiologistes n’en connaissent pas la pharmacologie complexe. Nous avons revu la pharmacologie et recommander un algorithme de traitement périopératoire pour les patients traités avec la méthadone.

Source

Une recherche dans Medline a été réalisée pour obtenir les publications sur la pharmacologie de la méthadone et son usage périopératoire.

Constatations principales

La complexité de la pharmacologie de la méthadone est caractérisée par une grande variabilité inter-individuelle, un potentiel d’interaction avec d’autres médicaments et une longue demi-vie d’élimination. Le traitement postopératoire des patients sous méthadone peut être difficile, car ils présentent souvent une «tolérance aux opiacés», mais ils peuvent être «intolérants à la douleur». Dans les cas de traitements d’entretien à la méthadone, il y a des problèmes possibles avec l’usage d’opiacés ou d’autres substances. Le plan de traitement des patients sous méthadone peut différer selon le type de chirurgie et les différences périopératoires associées de l’état de jeûne et de la fonction gastro-intestinale. En considérant tous ces facteurs, un algorithme de traitement est tracé pour les soins périopératoires des patients sous méthadone.

Conclusion

La méthadone est un opiacé aux propriétés complexes et l’anesthésie d’un patient sous méthadone peut représenter un grand défi. Une bonne connaissance de sa pharmacologie et du type de patients qui en consomment aidera à améliorer les soins périopératoires.

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Copyright information

© Canadian Anesthesiologists 2005

Authors and Affiliations

  • Philip W. H. Peng
    • 1
    • 2
    Email author
  • Paul S. Tumber
    • 1
    • 2
  • Douglas Gourlay
    • 1
    • 2
    • 3
  1. 1.Wasser Pain Management Pain CenterMount Sinai HospitalCanada
  2. 2.Department of Anesthesia and Pain ManagementUniversity Health Network, University of TorontoCanada
  3. 3.Centre for Addiction and Mental HealthA WHO Centre of ExcellenceTorontoCanada

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