Methadone for perioperative pain

Methadone is a long-acting opioid with rapid onset of action. It has a potent μ opioid receptor agonist and NMDA receptor antagonist activity, which helps to attenuate the development of hyperalgesia and tolerance. Its characteristic mechanism and distinctive pharmacological features make it most preferred in treating chronic and neuropathic pain and in replacement therapy for opiate abusers. Although it has been previously used as a perioperative analgesic, it did not receive global acceptance due to apprehension of respiratory depression and Q-T prolongation. With the global rise in average life expectancy, comorbidities requiring anticoagulant therapy have also exponentially increased, making perioperative pain management challenging in these patients, as central and peripheral nerve blockade is advised with caution. However, a review of recent investigations reveals that intraoperative methadone may be an exciting alternative, especially under these circumstances.