We thank Dr. Romanoff1  for his interest in our study of postoperative pain and analgesic requirements in the first year after intraoperative methadone for complex spine and cardiac surgery.2  Although the study was neither designed nor powered to determine the relationship between preoperative opioid use and postoperative analgesic requirements, we attempt to address his concerns with post hoc analyses.

Exclusion criteria for the study of intraoperative methadone for the prevention of postoperative pain in cardiac surgery patients included use of preoperative opioids or recent history of opioid abuse.3  Thus, preoperative opioid use could have no effect on their postoperative analgesic requirements.

Although the exclusion criteria for the study of intraoperative methadone in patients undergoing posterior spinal fusion surgery included preoperative use of methadone or hydromorphone and a recent history of opioid abuse,4  16 of the 27 (59%) patients in the hydromorphone group and 20 of the 39 (51%) patients in the methadone group for whom data were available at 3 months follow-up had taken opioids by prescription preoperatively (risk difference [99% CI], 7% [−25 to 36%]; Yates corrected chi square P = 0.782). Seven of the 11 (64%) patients in the hydromorphone group requiring analgesic medication at 3 months had taken opioids preoperatively, whereas one of the four (25%) patients in the methadone group requiring analgesic medication at 3 months had taken opioids preoperatively (risk difference [99% CI], 39% [−32 to 80%]; Fisher’s exact test P = 0.282). Seven of the 16 (44%) patients in the hydromorphone group taking opioids preoperatively required analgesic medication at 3 months, whereas four of the 11 (36%) patients not taking opioids preoperatively did (risk difference [99% CI], 7% [−40 to 50%]; Fisher’s exact test P > 0.999). One of the 20 (5%) patients in the methadone group taking opioids preoperatively required analgesic medication at 3 months, whereas three of the 19 (16%) patients not taking opioids preoperatively did (risk difference [99% CI], −11% [−42 to 20%]; Fisher’s exact test P = 0.342).

Thus, although the study was not powered to detect differences in the variables being tested in these post hoc analyses, the results suggest that there were no differences between the hydromorphone and methadone groups in either the proportion of patients who had taken opioids preoperatively or the proportion of patients who had taken opioids preoperatively requiring analgesic medication at 3 months. These analyses also suggest that there were no differences in the proportion of patients who took opioids preoperatively and required analgesic medication at 3 months and the proportion of patients who did not take opioids preoperatively and required analgesic medication at 3 months in either the hydromorphone or methadone groups.

Dr. Murphy has served as a speaker for Merck (Kenilworth, New Jersey). Dr. Avram is the Assistant Editor-in-Chief of Anesthesiology (Schaumburg, Illinois). Dr. Szokol declares no competing interests.

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