Evaluation of the analgesic effect of subcutaneous methadone after cesarean section

Authors
Mitra Jabalameli 1
Forough Kalantari 2
1 Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Anesthesia, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Inadequate pain control has a significant role in maternal and neonatal health in early post-partum period which interferes with breastfeeding and has a negative influence on child normal growth. The aim of this study is evaluation of subcutaneous methadone effectiveness on post-operative pain control.
Materials and Methods: Double blind randomized prospective clinical trial involving 60 term pregnancy patients through 2008 to 2009 Undergo cesarean. Inclusion criteria: Prime gravid candidate of elective cesarean and spinal anesthesia class 1 or 2. Known case of drug allergy and methadone interaction, addiction, uncontrolled medical disease excluded. Case group injected 10 mg of subcutaneous methadone in the site of incision before final suture. Morphine was a pain reliever in follow up examination. Data include mean of pain, nausea and vomiting, MAP, etc., collected and analyzed by independent-T test and Man Whitney test.
Results: Although mean usage of morphine between groups was not significant statistically but the mean pain severity (P value < 0.05) and mean satisfactory (P value = 0.02) was statistically significant between groups. Other parameters were not statistically significant.
Conclusion: We suggest subcutaneous methadone as a safe pain reliever in post cesarean section patients.

Keywords

1. Leung AY. Postoperative pain management in obstetric anesthesia-new challenges and solutions. J Clin Anesth 2004;16:57-65.  Back to cited text no. 1
    
2. Porter TF, Scott JR. Cesarean delivery. In: Scott JR, Gibbs RS, Karlan BY, editors. Danforth's obstetrics and gynecology. 9th ed. Philadelphia: Lippin Cott Williams Wilkins; 2003. p. 449.  Back to cited text no. 2
    
3. Gangnon B, Bruera E. Differences in the ratios of morphine to methadone in patients with neuropathic pain versus non-neuropathic pain. J Pain Symptom Manage 1999;18:120-5.  Back to cited text no. 3
    
4. Health Canada. Best Practices. Methadone Maintenance Treatment. Ottawa: Minister of Public Works and Government Services. Available from: http://www.hc-sc.gc.ca/hecs-sesc/cds/pdf/methadone_treatment_best_practices.pdf. [Last Updated on 2002].  Back to cited text no. 4
    
5. Fishman SM, Wilsey B, Mahajan G, Molina P. Methadone reincarnated: Novel clinical applications with related concerns. Pain Med 2002;3:339-48.  Back to cited text no. 5
    
6. Centeno C, Vara F. Intermittent subcutaneous methadone administration in the management of cancer pain. J Pain Palliat Care Pharmacother 2005;19:7-12.  Back to cited text no. 6
    
7. Shir Y, Rosen RN, Zeldin A, Davidson EM. Methadone is safe for treating hospitalized patients with severe pain. Can J Anaesth 2001;48:1109-13.  Back to cited text no. 7
    
8. Begg EJ, Malpas JT, Hackett LP, Ilett KF. Distribution of R- and S-methadone into human milk during multiple, medium to high oral dosing. Br J Clin Pharmacol 2001;52:681-5.  Back to cited text no. 8
    
9. Bruera E, Sweeney C. Methadone use in cancer patients with pain: A review. J Palliat Med 2002;5:127-38.  Back to cited text no. 9
    
10. Weissman DE. Subcutaneous opioid infusions fast fact and concept # 28. 2nd ed. Available from: http://www.eperc.mcw.edu [Last accessed on 2005 Jul].  Back to cited text no. 10
    
11. Kodali B, Jones S, Collins KA. Management of post-operative pain. Up to date equianalgesic opioid doses and available formulation. Available from: http//www.uptodate.com/online/content topic.do?topickey=anesth/3013 [Last accessed on 2010 May].  Back to cited text no. 11
    
12. Makin MK, Morley JS. Subcutaneous methadone in terminally-Ill patients. J Pain Symptom Manage 1999;18: 49-52.  Back to cited text no. 12
    
13. Hum A, Fainsinger RL, Bielech M. Subcutaneous methadone-an issue revisited. J Pain Symptom Manage 2007;34:573-5.  Back to cited text no. 13
    
14. Kodali BS, Oberoi JS. Management of post-operative pain in obstetrics and gynecology. Available from: http://utdol.com/online/content/topic.do?topicKey=gyn_surg/18533&selectedTitle=1~103 & source=search_result [Last accessed on 2008 Apr].  Back to cited text no. 14
    
15. Morphine sulfate: Drug information. Available from: http://utdol.com/online/content/topic.do?topicKey=drug_l_z/171919 & selectedTitle=1~150 & source=search_result [Last accessed on 2008 Nov].  Back to cited text no. 15
    
16. Twersky RS. Recovery and discharge of ambulatory anesthesia patient. Available from: http://www.asahq.org/rcls/RCLS_SRC/275_Twersky.pdf [Last accessed in 2012].  Back to cited text no. 16
    
17. Mercadante S, Sapio M, Serretta R. Patient-controlled analgesia with oral mathadone in cancer pain. Ann Oncol 1996;7:613-7.  Back to cited text no. 17
    
18. Mathew P, Storey P. Subcutaneous methadone in terminally ill patient: Manageable local toxicity. J Pain Symptom Manage 1999;18:49-52.  Back to cited text no. 18
    
19. Yoram SH, Vilarosen R. Methadone is safe for treaeing hospitalized patients with severe pain. Can J Anaesth 2000;48:1109-13.  Back to cited text no. 19
    
20. Mancini I, Hanson J, Bruera E. Opioid type and other clinical predictors of laxative dose in advanced cancer patients: A restrospective study. J Palliat Med 2000;3:49-56.  Back to cited text no. 20
Advanced Biomedical Research
Volume 2014, september
September 2014
Pages 1-5