Methadone analgesia in the critically ill.
Methadone is increasingly used as an analgesic or a bridge to weaning other analgesics and sedatives in critically ill patients. This review discusses the pharmacology of methadone, summarizes available evidence for its use in the intensive care unit setting, and makes suggestions for appropriate use and monitoring.



Articles evaluating the efficacy, safety, and pharmacology of methadone were identified from a PubMed search through June 2015. References from selected articles were reviewed for additional material. Experimental and observational English-language studies that focused on the efficacy, safety, and pharmacology of methadone in critically-ill adults and children were selected.



Methadone is a synthetic opioid analgesic with potential advantages over other commonly used opioids. Limited evidence from critically ill pediatric, adult, and burn populations suggests that methadone protocols may expedite weaning opiate infusions, decrease the length of mechanical ventilation, and reduce the incidence of negative outcomes such as opiate withdrawal, delirium, and over-sedation.



Data from current literature supports a role for methadone analgesia in weaning opiates and potentially reducing the duration of mechanical ventilation in critically ill patients. More studies are needed to confirm these benefits and determine criteria for patient selection.
Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH.
Jessica L
JL
Elefritz
Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH.
Claire V
CV
Murphy
Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH.
Thomas J
TJ
Papadimos
Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: michael.lyaker@osumc.edu.
Michael R
MR
Lyaker
D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D016638:Critical Illness; D003693:Delirium / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D008691:Methadone / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy*; D059408:Pain Management; D012121:Respiration, Artificial / Q000379:methods; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology / Q000209:etiology
D000701:Analgesics, Opioid; D008691:Methadone
Analgesia; Critical care; Intensive care units; Methadone; Opioid analgesics; Pain management