What we know and what we don’t know about the perioperative use of methadone in children and adolescents

Full text: https://onlinelibrary.wiley.com/doi/10.1111/pan.14584

This review article looks at methadone use in the paediatric perioperative population summarising the benefits and risks.

A brief description of the pharmacokinetics and pharmacodynamics is presented, along with potential benefits of using methadone perioperatively and the unknowns in this population. The article deduces that dosing strategies would likely be similar to that of adults. However, they also state that the minimal effective analgesic concentration has still not been ascertained in children.

The article goes on to review several retrospective and prospective studies of methadone use in posterior spinal fusion, cardiac and pectus excavatum surgery. They suggest intraoperative use of methadone reduces opioid requirements intraoperatively and postoperatively with similar or maybe less adverse effects and potentially reduced hospital stay. However, the studies were small, heterogenous and some with complex multifaceted pain protocols making interpretation difficult. Examples of potential perioperative dosing protocols including prn dosing and infusions are given.

Proposals for future development included procedure specific protocols, research into the use of methadone in routine paediatric surgery and safety and efficacy of methadone as a primary opioid for pain management. Additionally, they highlighted the lack of studies comparing opioid PCA vs methadone prn dosing or methadone PCA in the paediatric population.

Take home message

Methadone is a potential suitable and safe alternative to standard opiates in paediatric patients undergoing surgery, especially those with neuropathic pain. However, there remains gaps in knowledge regarding this area despite methadone being around since World War II.

Reviewed by Dr Sorcha Evans