Intraoperative Intravenous Methadone Utilization in Cardiac Surgery

Introduction: Intravenous methadone has been utilized as a preventative analgesic during anesthesia induction in cardiac surgery with the goal of reducing postoperative opioid use, while also considering other outcomes such as time on ventilator and ICU length of stay. Exploratory outcomes in a 2024 retrospective study of approximately 11,000 patients undergoing cardiac surgery at a large academic medical center showed that methadone (+ other opioids) was associated with shorter time to extubation (0.8 hours, p = 0.036) and approximately one day shorter stay in the ICU (1.2 days vs 2.1 days, p < 0.01). The goal of this project was to assess if using a long-acting opioid affects target quality metrics in the postoperative phase.


Methods: This is a retrospective quality improvement project assessing 357 patients who underwent cardiac surgery between February-April of 2024 and were admitted to the Cardiovascular Intensive Care Unit (CVICU) at a tertiary academic medical center. Patients 18 years of age and older were included. Patients with patient-controlled analgesia (PCA) or opioid patch administration or had passed away within 48 hours were excluded. Data collection included intravenous methadone dose, length of ICU stay, time on the vent, and 48-hour postoperative opioid medication doses recorded as oral morphine equivalents (OME). Other data included age and sex. Descriptive statistics, including central tendency and variability to quantify measured variables were applied.


Results: Of the 357 patients analyzed, 222 were male (62%), the median dose of IV methadone was 20.9 mg, and the median age was 65 years. Median vent hours reported were 4.45 hours vs 4.25 hours in the group that received methadone versus no-methadone, respectively. Median ICU hours were similar in both groups (56.2 hours in the methadone group versus 57.3 hours in the no-methadone group). A difference was noted in OME with the methadone group calculated at 67.50 versus the no-methadone group at 117.75.


Conclusions: Preliminary data suggests that there is a small numerical difference in vent hours favoring no methadone, but a higher calculated OME in that same group. Findings warrant further study to determine statistical and clinical significance on postoperative quality measures and changes to current local practice.