Impact of methadone maintenance therapy on postoperative pain control in patients undergoing laparoscopic abdominal surgery
Embargo Date
2026-02-14
OA Version
Citation
Abstract
OBJECTIVE: Opioid addiction has become an epidemic in the United States. Chronic use of opioids dysregulates the reward and pain pathways in the body, manifesting as addiction, tolerance, and hyperalgesia. Methadone, an opioid agonist, is commonly used to for long term treatment of opioid use disorder. Methadone maintenance therapy is highly effective due to its long elimination half-life of 24 to 36 hours and high oral bioavailability. However, the long term effects from opioid misuse and methadone maintenance therapy can pose an issue for clinicians when treating surgical or postsurgical pain. Therefore, the objective of this study was to investigate how methadone maintenance therapy affects postoperative pain control.
METHODS: A total of 125 patients who underwent laparoscopic cholecystectomy, appendectomy, hernia repair or gastric bypass at Boston Medical Center between 2014 and 2022 were enrolled in this study; 42 patients on methadone maintenance therapy and 83 controls. Demographical and clinical variables were collected for both groups, and then compared using a Wilcoxon Rank Sum test for continuous variables and Fisher exact test for categorical variables. A univariate analysis was performed using demographic and clinical variables to determine which were associated with morphine milligram equivalents (MME) requirements in methadone users. A multivariate logistic regression analysis was then performed using the four variables with the lowest p-value from the univariate analysis.
RESULTS: Methadone users had a higher prevalence of homelessness (p = 0.022), polysubstance use disorder (p < 0.001), marijuana use (p < 0.001 ), and a history of smoking (p < 0.001). Methadone users had lower intraoperative maximum mean arterial pressures (p = 0.21), and higher intraoperative MME requirements compared to methadone non-users (p = 0.001). Local anesthesia was more frequently employed in methadone users (p = 0.0031). Methadone users had higher postoperative maximum pain scores (p <0.001***), and a longer hospital length of stay (p = 0.01). Methadone users had a higher total MME requirement during their hospital stay (p < 0.001).
CONCLUSIONS: Patients on methadone maintenance had higher MME requirements during their hospital stay. Our results support the need for multimodal approaches to pain management in methadone users undergoing laparoscopic abdominal surgery.