Development and Implementation of an Intraoperative Methadone Guideline for Complex Spinal Surgery

Abstract Background: The recent and ongoing opioid epidemic in the United States has been very detrimental to the country’s overall health and has led to devastating patient outcomes. There is a responsibility on the part of healthcare providers to do their part in reducing these negative consequences. Purpose: This quality improvement project was to develop and implement an evidence-based guideline for intraoperative methadone administration during complex spine surgery. Data was collected to evaluate whether this intervention correlated with reduced postoperative pain and narcotic use. Methods: Education was provided to the clinical associates of Kalamazoo Anesthesiology regarding the guideline components and associated benefits of methadone. The guideline was implemented for all patients undergoing complex spine surgery at Bronson Methodist Hospital. At the conclusion of the implementation period, provider adherence to the guideline was assessed as well as patient outcomes for patients who received all components of the methadone guideline. Results: Complete provider adherence to the methadone guideline occurred in five out of 22 (22.7%) opportunities. A Wilcoxon test showed a statistically significant finding in patients who received methadone who reported decreased pain scores (p = .015) post-operatively. This test showed that patients who did not receive methadone reported a pain score of well over double (mean = 9.57) as compared to those who received intraoperative methadone (2.67).
Conclusion: Despite knowledge of current literature and the methadone guideline components, anesthesia providers had a low level of adherence to the protocol, overall. Patients who did receive all elements of the methadone guideline demonstrated decreased consumption of opioids and pain levels in the postoperative period.