Methadone Dosing and Postoperative Pain Management in Cardiothoracic Surgery: A Retrospective Cohort Study

Cardiac surgery is associated with significant postoperative pain. Methadone reduces postoperative pain and opioid consumption after cardiothoracic procedures, but the dosing of intraoperative methadone is unclear.¹  Our previous investigation of this retrospective cohort found that the use of intraoperative methadone was associated with lower pain scores and lower postoperative oral morphine equivalents after cardiac surgery compared to shorter acting opioids, but we did not examine dosing of methadone.¹  This secondary analysis of that previous study¹  provides dose–response relationships for methadone administered intraoperatively to cardiac surgery patients for both analgesia and adverse effects.

Details of the study sample have been previously reported, but briefly, this retrospective cohort study (Mayo Clinic Institutional Review Board approval No. 22-007486) included 12,017 adults who underwent cardiac surgery with cardiopulmonary bypass from 2018 to 2023 at a large, multisite healthcare system.¹  The primary outcome of interest for this analysis was patient- and...