Currently, there is a nationwide epidemic of opioid abuse and overdose deaths. One source of excess opioids is overprescribing in the postoperative period. This study aims to find the optimal pain medication plan during and after laparoscopic hysterectomy to eliminate long-term opioid use.
Given the increasing opioid abuse and over-prescription post-operatively, an effort should be made to determine whether one time dosing of Methadone, a longer opioid analgesics, intra-operatively is an adequate potential in treating postoperative pain after hysterectomy surgeries. The investigators hypothesize that this could minimize the need for additional post-operative and outpatient opioid prescriptions and decrease the adverse effects that are associated with the consumption, including new opioid abuse.
Intervention group will receive methadone intraoperatively while the other group would receive short-acting opioids (standard).
Individuals with a uterus
Age 18 years old and above
Undergoing minimally invasive (laparoscopic or robotic) hysterectomy with ovarian preservation
Benign indications for hysterectomy
Chronic pain syndromes patients including fibromyalgia
Patients currently on long-term (i.e. for more than three months) opioid use
Patients currently on agonist-antagonist medications (e.g. buprenorphine)
Patients taking a selective serotonin reuptake inhibitor or monoamine oxidase inhibitor
Parallel
Methadone
DrugIntra-operative single dose IV Methadone (0.25 mg/kg of ideal body weight)
Total post-operative opioid requirements in oral morphine milligram equivalents (MME)
Total post-operative opioid requirements in oral morphine milligram equivalents (MME) in first 7 post operative days.
Mobility and satisfaction of analgesia
Mobility and satisfaction of analgesia on post-operative day one and seven (binary question Y/N)
Number of unplanned returns to emergency room/clinic or patient initiated phone call regarding pain
Overall satisfaction with pain control
0-10 scale (0- no pain, 10-worst pain)
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