Methadone is a utilitarian opioid with multiple applications in anesthesiology, acute pain, cancer pain, sickle cell disease, and opioid use disorder, in both adults and children. Although methadone was only modestly popular after initial introduction to anesthesia practice in the early 1980s, subsequent “reintroduction” more than 20 yr later spurred growing use in the ensuing decade. Multiple clinical studies have demonstrated the clinical benefits and therapeutic advantages of perioperative long-duration methadone compared with shorter-duration opioids, for both inpatient and outpatient surgery. Patients receiving a single intraoperative dose of methadone, compared with shorter-duration opioids, report less pain, use less opioid, and have greater satisfaction with pain relief. Moreover, these advantages seem to persist for weeks or months after surgery.4,5  Indeed, methadone is aptly described as an “opioid-sparing opioid.”

Compared with other opioids,...

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