Enhanced recovery after surgery (ERAS) protocols often aim to reduce the use of opioids both during and after surgery to minimize their negative effects on respiratory and bowel function. To date, only one study has directly investigated methadone's impact on postoperative bowel function, suggesting that while methadone's use might reduce the need for additional opioids, potentially aiding bowel motility, its long elimination phase could delay bowel motility recovery. This area requires further study to clarify methadone's overall impact on bowel function, recovery quality, length of hospital stay, and post-discharge outcomes within ERAS protocols. Only one study has specifically looked at methadone within an ERAS pathway for spinal fusion surgery.
Research typically evaluates methadone's role in postoperative pain management without the confounding effects of other opioid-sparing strategies. Results from such studies, including one by Singhal et al., indicate that incorporating methadone into a multimodal pain management approach can lead to reduced pain levels, lower analgesic needs, and shorter hospital stays. These findings support the integration of methadone into multimodal strategies for enhancing postoperative recovery. However, combining methadone with other ERAS protocol components, such as gabapentinoids, warrants caution due to increased risks of postoperative respiratory depression. Conversely, combining methadone with ketamine may offer synergistic pain relief benefits and reduce opioid consumption, highlighting the need for further research to establish methadone's optimal role in ERAS protocols and multimodal pain management.
