Problem:
The relief of moderate to severe postoperative pain in surgeries including abdominal
surgeries continues to pose a major therapeutic dilemma. The traditional and most common
therapy is the administration of short-acting opioid analgesics, intra-operative and
post-operative, at intervals every 3-4 hours. However, the use of opioids with relatively
short plasma half-lives at varying intervals may lead to various fluctuating drug
concentrations in plasma, and side effects including respiratory, longer
hospitalizations, delayed ambulation, inadequate pain relief and potential avenues for
abuse. Identifying a more efficient and safer therapy for intraoperative pain analgesia
can be helpful in controlling pain requirements in the post-operative setting.
In major inpatient and ambulatory surgeries, intraoperative single-dose methadone,
through its unique pharmacology, has been shown to produce better analgesia, reduce
opioid use and minimize adverse side effects compared with conventional repeated dosing
of short-duration opioids. Additionally, methadone is theorized to be an
N-methyl-D-aspartate (NMDA) receptor noncompetitive antagonist, which may contribute to
its increase in analgesic potential as compared with fentanyl analogues. Finally, it has
been shown to improve ambulation in the post operative anesthesia setting and pain
control in chronic pain patients. The study of intra-operative methadone has not been
extensively studied for gynecology surgeries, but one study has shown the decrease of
mean opioid consumption post operatively after receiving one dose of intra-operative
methadone compared to shorter acting opioids in same-day laparoscopic myomectomy. Given
the increasing opioid abuse and over-prescription post-operatively, an effort should be
made to determine whether one time dosing of longer opioid analgesics intra-operatively
is an adequate potential in treating postoperative pain after hysterectomy surgeries and
could minimize the need for additional post-operative and outpatient opioid
prescriptions.
This study aims at addressing the requirement for postoperative opioid prescription after
intraoperative longer acting vs shorter acting opioids in laparoscopic hysterectomy.
Hypothesis:
Single dose of intra-operative methadone is an adequate potential in treating
post-operative pain after laparoscopic total hysterectomy surgeries, reducing the
additional need for post-operative and outpatient opioid prescriptions and decreasing the
adverse effects associated with opioid consumption.
Importance of research:
Given the increasing opioid abuse and over-prescription post-operatively, an effort must
be made to determine whether one time dosing of longer opioid analgesics intraoperatively
in conjunction with non-opioid multimodal medications is adequate to treat postoperative
pain after laparoscopic hysterectomy. Additionally, this intervention may decrease the
need for additional prescriptions or unscheduled patient contacts.