The Journal of Bone and Joint Surgery (American). 2005;87:140-144.
doi:10.2106/JBJS.D.01912
© 2005 The Journal of Bone and Joint Surgery, Inc.
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The Effect of Intra-Articular Methadone on Postoperative Pain Following Anterior Cruciate Ligament Reconstruction

David J. Stewart, CRNA, MS1, Edward W. Lambert, DO1, Kimberly M. Stack, CRNA, MS1, Joseph Pellegrini, CRNA, DNSc2, Daniel V. Unger, MD1 and Raymond J. Hood, CRNA, MS1

1 Department of Anesthesia (D.J.S., K.M.S., and R.J.H.) and Bone and Joint Sports Medicine Institute (E.W.L. and D.V.U.), Naval Medical Center, 620 John Paul Jones Circle, Portsmouth, VA 23708. E-mail address for E.W. Lambert: lamberte{at}hss.ed
2 Naval School of Health Sciences, 8901 Wisconsin Avenue, Bethesda, MD 20889

Investigation performed at the Departments of Orthopaedic Surgery and Anesthesia, Naval Medical Center, Portsmouth, Virginia

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The views expressed in this paper are those of the authors and do not reflect the official policy or position of the Department of the Navy, the Department of Defense, or the United States government.

Background: Intra-articular narcotics have proven efficacy for providing pain relief following knee arthroscopy. This effect is short-lived. Methadone, with its long serum half-life (thirty-five hours, compared with two hours for morphine) could provide improved and prolonged pain relief. The purpose of the present study was to examine the effects of an intra-articular injection of methadone on postoperative analgesia following arthroscopic anterior cruciate ligament reconstruction.

Methods: Sixty-five skeletally mature patients undergoing primary anterior cruciate ligament reconstruction were randomly assigned to one of three groups, all of which received an intra-articular injection consisting of 9.5 mL of 0.5% bupivacaine with 1:200,000 epinephrine at the completion of the procedure. In addition, the remaining 0.5 mL of the syringe was filled with one of three substances. The study group (twenty-five patients) received 5 mg of methadone, the comparison group (twenty-one patients) received 5 mg of morphine, and the control group (nineteen patients) received 0.5 mL of saline solution. All supplemental pain medications were given on an as-needed basis, recorded, and converted to morphine equivalents. Specific variables that were measured included supplemental analgesia requirements during both the inpatient period and the outpatient period (from the time of discharge to the seventh postoperative day) and pain scores.

Results: There was no significant difference in inpatient (p = 0.998) or outpatient (p = 0.887) supplemental analgesic requirements or pain scores between the methadone group (Group 1) and the control group (Group 3). The morphine group (Group 2) required significantly less inpatient (p = 0.014) and outpatient (p = 0.044) supplemental analgesia compared with the control group (Group 3). There were no complications.

Conclusions: The present report represents the first known study of the use of intra-articular methadone and establishes that this analgesic is safe at a single dose of 5 mg. At this dose, however, methadone does not provide improved postoperative analgesia following arthroscopic anterior cruciate ligament reconstruction. In contrast, intra-articular morphine does appear to be effective for decreasing postoperative pain.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


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Related articles in JBJS:

The Effect of Intra-Articular Methadone on Postoperative Pain Following Anterior Cruciate Ligament Reconstruction • E.W. Lambert, R.J. Hood, and D.V. Unger reply:
Hasan Hilmi Muratli, Serife Nursel Muratli, Ali Bicimoglu, Nermin Gogus, Edward W. Lambert, Raymond J. Hood, and Daniel V. Unger
JBJS 2005 87: 1883-1884. [Extract] [Full Text]  



Letters to the Editor:

Read all Letters to the Editor

Intraarticular analgesics' effects on the donor site in the ACL reconstructions
Hasan Hilmi Muratli, et al.
JBJS Online, 15 Feb 2005 [Full text]
Dr. Lambert responds to Dr. Muratli
Edward W. Lambert, et al.
JBJS Online, 15 Feb 2005 [Full text]