Questions · Intraoperative Methadone
9 questions, 0 approved. Approve them one at a time — a quiz shows nothing you have not.
Recall — derived from a kept point
In the randomised comparison of intraoperative methadone with a sufentanil infusion in patients undergoing complex multilevel spine surgery, state the methadone dose and when it was given, and state what happened to opioid requirement and to pain scores afterwards.
Answer: A single methadone bolus of 0.2 mg/kg was given before incision. Compared with a sufentanil infusion it halved opioid requirement at 48 and 72 hours and halved pain scores at 48 hours.
One 0.2 mg/kg dose before incision is the regimen behind the halved opioid requirement at 48 and 72 hours in this multilevel spine trial.
Source claim: A single 0.2 mg/kg methadone bolus before incision in multilevel spine surgery halved opioid requirement at 48 and 72 hours and halved pain scores at 48 hours versus a sufentanil infusion.
Intraoperative Methadone Improves Postoperative Pain Control in Patients Undergoing Complex Spine Surgery, Anesthesia and analgesia 2011
recall · CA-1 · phrased by llm
A resident is reluctant to give intraoperative methadone because of the sedation and respiratory depression they expect from a long-acting opioid. Using the pooled data from the ten-study meta-analysis of intraoperative methadone, state how large the analgesic benefit actually was and what the pooled data showed about those side effects.
Answer: Pooled across ten studies, methadone reduced 24-hour opioid consumption by only about 15 mg oral morphine equivalents and improved analgesia satisfaction. There was no difference in nausea, sedation or respiratory depression, so the feared side effects did not appear in the pooled data — but the analgesic effect size is modest, about 15 mg of oral morphine equivalents over 24 hours.
The pooled signal is a modest 15 mg oral morphine equivalent reduction with better satisfaction and no excess nausea, sedation or respiratory depression.
Source claim: Pooled across ten studies, methadone reduced 24-hour opioid consumption by about 15 mg oral morphine equivalents and improved analgesia satisfaction, with no difference in nausea, sedation or respiratory depression.
Intraoperative Methadone Administration and Postoperative Pain Control: A Systematic Review and Meta-Analysis, Pain 2020
recall · CA-2 · phrased by llm
Methadone is often avoided intraoperatively over QT concerns. In the prospective observational cohort of single-dose intraoperative methadone, what happened to the QTc, what were the rates of a new QTcF above 500 ms with and without methadone, and was there any relationship between the dose given and the QTcF?
Answer: A single induction dose of intravenous methadone did not prolong the QTc. A new QTcF above 500 ms occurred in 2.5% of patients who received methadone versus 8.3% of those who did not, and there was no correlation between dose and QTcF. Because this is a prospective observational cohort, it shows no observed QTc prolongation rather than proving methadone is safe in any given patient.
In this observational cohort a single induction dose did not prolong the QTc, and new QTcF above 500 ms was actually less frequent with methadone than without it — 2.5% versus 8.3%.
Source claim: A single induction dose of intravenous methadone did not prolong the QTc: new QTcF above 500 ms occurred in 2.5% with methadone versus 8.3% without, with no correlation between dose and QTcF.
Single-Dose Intraoperative Methadone and QTc Interval: A Prospective Observational Cohort Investigation, British journal of anaesthesia 2026
recall · CA-2 · phrased by llm
A resident cites the 13-trial meta-analysis of intraoperative methadone and says the sequential analysis proves the question is settled and no more research is needed. Name the outcomes and time points the meta-analysis actually reported, then state exactly which single outcome and time window the sequential analysis declared needed no further trials.
Answer: The meta-analysis reported that across 13 trials intraoperative methadone lowered pain at rest and on movement at 24, 48 and 72 hours and cut opioid consumption. The sequential analysis indicated no further trials are needed only for pain at rest out to 48 hours. That closure statement does not extend to pain on movement, to the 72-hour time point, or to opioid consumption.
The sequential analysis closes exactly one cell of that table — pain at rest to 48 hours — and says nothing about pain on movement, 72 hours, or opioid consumption.
Source claim: Across 13 trials, intraoperative methadone lowered pain at rest and on movement at 24, 48 and 72 hours and cut opioid consumption, with sequential analysis indicating no further trials are needed for pain at rest to 48 hours.
Intraoperative Methadone Reduces Pain and Opioid Consumption in Acute Postoperative Pain: A Systematic Review and Meta-Analysis, Anesthesia and analgesia 2019
recall · CA-3 · phrased by llm
A single intraoperative dose of methadone ≥___ mg/kg results in less postoperative pain and opioid consumption compared to short-acting IV opioids in adult cardiac surgery patients.
Answer: 0.2
A single intraoperative dose of methadone ≥0.2 mg/kg results in less postoperative pain and opioid consumption compared to short-acting IV opioids in adult cardiac surgery patients.
The Use of Methadone in Adult Cardiac Surgery: A Systematic Review With Narrative Synthesis · PMID 42085333
recall · CA-3 · phrased by derived
The point with one number taken out. No model wrote any of this: the stem is the sentence you reviewed, minus a digit, and the paper it came from is named beneath it.
Open prompts
How would you teach this to a CA-1 in two minutes?
open · CA-3 · phrased by derived
Where does the evidence for this actually stop?
open · CA-3 · phrased by derived
What would you do differently in a resource-limited setting?
open · CA-3 · phrased by derived
Defend the alternative you decided against.
open · CA-3 · phrased by derived
Questions only — nothing here asserts anything, which is why a model is allowed to phrase them. Where no model was reachable these are the level defaults.