# Perioperative Methadone in Orthopedic Surgery: A Scoping Review

## TL;DR

This review explores how methadone used during orthopedic surgery can reduce postoperative pain and opioid use, especially in spine surgeries.

## Contribution

The study provides a qualitative synthesis of methadone's efficacy and safety in orthopedic surgery across different contexts.

## Key findings

- Methadone reduced opioid use by up to 50% in adult spine surgery.
- Methadone in pediatric spine surgery reduced opioid use by up to 76% in multimodal regimens.
- Methadone showed acceptable safety with no major adverse events when dosed appropriately.

## Abstract

Background/Objective: The present study is a scoping review of the literature from Medline, PubMed, and Scopus databases from 2000 to 2025. Studies were selected based on predefined criteria, including the intraoperative administration of methadone during orthopedic surgery and the reporting of outcomes such as pain scores, opioid consumption, or adverse effects. A qualitative synthesis of the findings from 13 selected studies was performed to evaluate the existing literature on the efficacy and safety of perioperative methadone for postoperative pain management in orthopedic surgery. Methods: Studies were selected based on predefined criteria, including the intraoperative administration of methadone during orthopedic surgery and the reporting of outcomes such as pain scores, opioid consumption, or adverse effects. A qualitative synthesis of the findings from 13 selected studies was performed. Results: Randomized controlled trials in adult spine surgery consistently showed that intraoperative methadone (0.2 mg/kg) significantly reduced postoperative opioid consumption by up to 50% and lowered pain scores for up to 72 h compared to other opioids. Similar benefits were observed in pediatric spine surgery, particularly with multimodal regimens including methadone, which reduced total opioid use by as much as 76%. However, for arthroscopic knee surgery, morphine provided superior analgesia compared to methadone. The safety profile of perioperative methadone appears acceptable, with no major adverse events reported when dosed appropriately. Conclusions: Perioperative methadone is an effective analgesic adjunct that reduces postoperative pain and opioid requirements, especially in major spine surgery when integrated into a multimodal strategy. Its efficacy varies by surgical context, and further high-quality research is needed to define optimal dosing and its role in other orthopedic procedures.