Intraoperative methadone for postoperative pain in adult patients undergoing tonsillectomy—a randomised controlled trial

Michael Bøndergaard; Peter Gaarsdal Uhrbrand; Tutku Karaca; Marianne Rhode; Thomas Kjærgaard; Rene Thunberg Svendsen; Tejs Ehlers Klug; Lone Nikolajsen; Kristian Dahl Friesgaard

doi:10.1016/j.bjao.2025.100418

Intraoperative methadone for postoperative pain in adult patients undergoing tonsillectomy—a randomised controlled trial

Michael Bøndergaard, Peter Gaarsdal Uhrbrand, Tutku Karaca, Marianne Rhode, Thomas Kjærgaard, Rene Thunberg Svendsen, Tejs Ehlers Klug, Lone Nikolajsen, Kristian Dahl Friesgaard^*

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

Abstract

Background: Tonsillectomy is a common procedure often associated with severe postoperative pain. This study hypothesised that methadone would provide superior postoperative pain relief and reduced opioid consumption compared with fentanyl. Methods: A total of 120 adult patients undergoing elective bilateral tonsillectomy were randomly allocated to receive either methadone (0.2 mg kg⁻¹; n=62) or fentanyl (3 μg kg⁻¹; n=58) after anaesthesia induction. Joint primary outcomes were pain intensity (numeric rating scale, 0–10) at swallowing upon postanaesthesia care unit (PACU) arrival and cumulative opioid consumption (oral morphine equivalents) over 5 postoperative days. Secondary outcomes included pain at swallowing, PACU and hospital stay duration, sedation at 4 h, patient satisfaction at days 1 and 7, postoperative nausea/vomiting (PONV) on days 1–3, and PACU adverse events. Results: Cumulative 5-day opioid consumption was lower in the methadone group (30 mg, inter-quartile range [IQR] 10–50 mg) vs the fentanyl group (49 mg, IQR 29–80 mg, P=0.002), driven by reduced use on day 1. Pain intensity was lower in the methadone group compared with the fentanyl group in the PACU (4, IQR 3–5 vs 5, IQR 4–7, P=0.0004), at 24 h (P=0.005) and 48 h (P=0.03). More patients in the methadone group experienced moderate to severe PONV at 24 h (45.0%, vs 14.1%, P=0.001), 48 h (43.3% vs 17.6%, P=0.005), and 72 h (33.9% vs 18.2%, P=0.03). Secondary outcomes, including patient satisfaction, sedation, and discharge times, did not differ significantly. Conclusion: Methadone reduced opioid consumption and pain intensity but increased PONV. Identifying risk factors for both severe postoperative pain and PONV may help guide patient selection for methadone use. Clinical trial registration: NCT05445856, EudraCT ID 2022-002496-11.

Originalsprog	Engelsk
Artikelnummer	100418
Tidsskrift	BJA Open
Vol/bind	14
ISSN	2772-6096
DOI	https://doi.org/10.1016/j.bjao.2025.100418
Status	Udgivet - jun. 2025

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@article{3d625c52255b4d69b1feb5c854e6e390,

title = "Intraoperative methadone for postoperative pain in adult patients undergoing tonsillectomy—a randomised controlled trial",

abstract = "Background: Tonsillectomy is a common procedure often associated with severe postoperative pain. This study hypothesised that methadone would provide superior postoperative pain relief and reduced opioid consumption compared with fentanyl. Methods: A total of 120 adult patients undergoing elective bilateral tonsillectomy were randomly allocated to receive either methadone (0.2 mg kg−1; n=62) or fentanyl (3 μg kg−1; n=58) after anaesthesia induction. Joint primary outcomes were pain intensity (numeric rating scale, 0–10) at swallowing upon postanaesthesia care unit (PACU) arrival and cumulative opioid consumption (oral morphine equivalents) over 5 postoperative days. Secondary outcomes included pain at swallowing, PACU and hospital stay duration, sedation at 4 h, patient satisfaction at days 1 and 7, postoperative nausea/vomiting (PONV) on days 1–3, and PACU adverse events. Results: Cumulative 5-day opioid consumption was lower in the methadone group (30 mg, inter-quartile range [IQR] 10–50 mg) vs the fentanyl group (49 mg, IQR 29–80 mg, P=0.002), driven by reduced use on day 1. Pain intensity was lower in the methadone group compared with the fentanyl group in the PACU (4, IQR 3–5 vs 5, IQR 4–7, P=0.0004), at 24 h (P=0.005) and 48 h (P=0.03). More patients in the methadone group experienced moderate to severe PONV at 24 h (45.0%, vs 14.1%, P=0.001), 48 h (43.3% vs 17.6%, P=0.005), and 72 h (33.9% vs 18.2%, P=0.03). Secondary outcomes, including patient satisfaction, sedation, and discharge times, did not differ significantly. Conclusion: Methadone reduced opioid consumption and pain intensity but increased PONV. Identifying risk factors for both severe postoperative pain and PONV may help guide patient selection for methadone use. Clinical trial registration: NCT05445856, EudraCT ID 2022-002496-11.",

keywords = "acute postoperative pain, methadone, pain management, postoperative, tonsillectomy",

author = "Michael B{\o}ndergaard and Uhrbrand, {Peter Gaarsdal} and Tutku Karaca and Marianne Rhode and Thomas Kj{\ae}rgaard and Svendsen, {Rene Thunberg} and Klug, {Tejs Ehlers} and Lone Nikolajsen and Friesgaard, {Kristian Dahl}",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s)",

year = "2025",

month = jun,

doi = "10.1016/j.bjao.2025.100418",

language = "English",

volume = "14",

journal = "BJA Open",

issn = "2772-6096",

publisher = "Elsevier B.V.",

}

TY - JOUR

T1 - Intraoperative methadone for postoperative pain in adult patients undergoing tonsillectomy—a randomised controlled trial

AU - Bøndergaard, Michael

AU - Uhrbrand, Peter Gaarsdal

AU - Karaca, Tutku

AU - Rhode, Marianne

AU - Kjærgaard, Thomas

AU - Svendsen, Rene Thunberg

AU - Klug, Tejs Ehlers

AU - Nikolajsen, Lone

AU - Friesgaard, Kristian Dahl

PY - 2025/6

Y1 - 2025/6

N2 - Background: Tonsillectomy is a common procedure often associated with severe postoperative pain. This study hypothesised that methadone would provide superior postoperative pain relief and reduced opioid consumption compared with fentanyl. Methods: A total of 120 adult patients undergoing elective bilateral tonsillectomy were randomly allocated to receive either methadone (0.2 mg kg−1; n=62) or fentanyl (3 μg kg−1; n=58) after anaesthesia induction. Joint primary outcomes were pain intensity (numeric rating scale, 0–10) at swallowing upon postanaesthesia care unit (PACU) arrival and cumulative opioid consumption (oral morphine equivalents) over 5 postoperative days. Secondary outcomes included pain at swallowing, PACU and hospital stay duration, sedation at 4 h, patient satisfaction at days 1 and 7, postoperative nausea/vomiting (PONV) on days 1–3, and PACU adverse events. Results: Cumulative 5-day opioid consumption was lower in the methadone group (30 mg, inter-quartile range [IQR] 10–50 mg) vs the fentanyl group (49 mg, IQR 29–80 mg, P=0.002), driven by reduced use on day 1. Pain intensity was lower in the methadone group compared with the fentanyl group in the PACU (4, IQR 3–5 vs 5, IQR 4–7, P=0.0004), at 24 h (P=0.005) and 48 h (P=0.03). More patients in the methadone group experienced moderate to severe PONV at 24 h (45.0%, vs 14.1%, P=0.001), 48 h (43.3% vs 17.6%, P=0.005), and 72 h (33.9% vs 18.2%, P=0.03). Secondary outcomes, including patient satisfaction, sedation, and discharge times, did not differ significantly. Conclusion: Methadone reduced opioid consumption and pain intensity but increased PONV. Identifying risk factors for both severe postoperative pain and PONV may help guide patient selection for methadone use. Clinical trial registration: NCT05445856, EudraCT ID 2022-002496-11.

AB - Background: Tonsillectomy is a common procedure often associated with severe postoperative pain. This study hypothesised that methadone would provide superior postoperative pain relief and reduced opioid consumption compared with fentanyl. Methods: A total of 120 adult patients undergoing elective bilateral tonsillectomy were randomly allocated to receive either methadone (0.2 mg kg−1; n=62) or fentanyl (3 μg kg−1; n=58) after anaesthesia induction. Joint primary outcomes were pain intensity (numeric rating scale, 0–10) at swallowing upon postanaesthesia care unit (PACU) arrival and cumulative opioid consumption (oral morphine equivalents) over 5 postoperative days. Secondary outcomes included pain at swallowing, PACU and hospital stay duration, sedation at 4 h, patient satisfaction at days 1 and 7, postoperative nausea/vomiting (PONV) on days 1–3, and PACU adverse events. Results: Cumulative 5-day opioid consumption was lower in the methadone group (30 mg, inter-quartile range [IQR] 10–50 mg) vs the fentanyl group (49 mg, IQR 29–80 mg, P=0.002), driven by reduced use on day 1. Pain intensity was lower in the methadone group compared with the fentanyl group in the PACU (4, IQR 3–5 vs 5, IQR 4–7, P=0.0004), at 24 h (P=0.005) and 48 h (P=0.03). More patients in the methadone group experienced moderate to severe PONV at 24 h (45.0%, vs 14.1%, P=0.001), 48 h (43.3% vs 17.6%, P=0.005), and 72 h (33.9% vs 18.2%, P=0.03). Secondary outcomes, including patient satisfaction, sedation, and discharge times, did not differ significantly. Conclusion: Methadone reduced opioid consumption and pain intensity but increased PONV. Identifying risk factors for both severe postoperative pain and PONV may help guide patient selection for methadone use. Clinical trial registration: NCT05445856, EudraCT ID 2022-002496-11.

KW - acute postoperative pain

KW - methadone

KW - pain management

KW - postoperative

KW - tonsillectomy

UR - http://www.scopus.com/inward/record.url?scp=105005939743&partnerID=8YFLogxK

U2 - 10.1016/j.bjao.2025.100418

DO - 10.1016/j.bjao.2025.100418

M3 - Journal article

AN - SCOPUS:105005939743

SN - 2772-6096

VL - 14

JO - BJA Open

JF - BJA Open

M1 - 100418

ER -

Intraoperative methadone for postoperative pain in adult patients undergoing tonsillectomy—a randomised controlled trial

Abstract

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