Cardiothoracic & vascular anesthesia
The Use of Methadone in Adult Cardiac Surgery: A Systematic Review With Narrative Synthesis
Authors' conclusion
The composite data suggest that a single dose of intraoperative methadone results in less postoperative pain and opioid consumption postoperatively without any increased risk for QTc prolongation or respiratory depression.
Study context
- Population
- Adult cardiac surgical patients16 publications
- Comparison
- Intraoperative methadone vs short-acting intravenous (IV) opioids
- Outcome
- Postoperative pain and opioid consumption
Methodological detailsrisk of bias and quality of evidence assessed, MEDLINE and EMBASE searched; data presented in narrative format
- Risk of bias and quality of evidence assessed
- MEDLINE and EMBASE searched; data presented in narrative format
Pooled result
As reported in the abstract
- Single dose of intraoperative methadone results in less postoperative pain and opioid consumption, without increased risk for QTc prolongation or respiratory depression
- 0.1 mg/kg: equivocal analgesia
- ≥0.2 mg/kg: consistently lower postoperative pain scores and opioid consumption vs short-acting IV opioids
- Evidence of a dose-response relationship with analgesic benefits and increased deliriogenic side effects
- CPB significantly impacts methadone plasma concentrations
- Certainty of the evidence is low
Safety
QTc prolongation, respiratory depression, delirium
- No increased risk for QTc prolongation or respiratory depression
- Increased deliriogenic side effects with higher doses (dose-response)
Original publication
The Use of Methadone in Adult Cardiac Surgery: A Systematic Review With Narrative Synthesis. Anesth Analg. Published 5 May 2026. doi:10.
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