Authors: Hand BA, Dholakia R, Smith BB, Borah JB, Chapital AB, Milam AJ
Anesthesia & Analgesia ():10.1213/ANE.0000000000007684, August 06, 2025.
This retrospective cohort analysis evaluated the financial implications of intraoperative methadone use in 12,017 adults undergoing cardiac surgery with cardiopulmonary bypass between 2019 and 2023 at a large multisite healthcare system. Methadone is known to reduce postoperative pain and opioid consumption compared with shorter-acting opioids but may be associated with longer time to extubation, prolonged hospital stay, and increased postoperative nausea, vomiting, and delirium.
Patients were divided into three groups: no opioid, intraoperative methadone, or intraoperative morphine/hydromorphone. Financial analysis, based on hospital cost data adjusted for inflation, found no statistically significant difference in total hospitalization costs between the methadone and comparator groups. Cost components—such as ICU and floor stay, pharmacy, and anesthesia—were also similar, suggesting methadone use does not increase perioperative costs despite potential clinical trade-offs.
The authors conclude that methadone remains a cost-neutral option for cardiac surgery analgesia, supporting its continued consideration in perioperative pain management strategies.
Thank you to Anesthesia & Analgesia for allowing the use of this article.