乳腺癌是最常见的癌症类型，也是女性癌症相关死亡的第二大原因。乳房切除术仍然是非转移性乳腺癌治疗的关键组成部分，治疗术后急性疼痛的策略仍然是一个重要的临床挑战，这种并发症几乎影响所有接受手术的患者。本研究旨在确定与传统短效阿片类药物相比，术中使用美沙酮对接受乳房切除术的女性疼痛相关围手术期结局的影响。这项单中心回顾性研究包括接受全乳房切除术的成年女性。本研究的主要结果是术后第一天的术后疼痛强度。次要结局包括围手术期阿片类药物的消耗量、围手术期非阿片类镇痛药的使用、手术和麻醉持续时间、拔管时间、麻醉后监护室 (PACU) 的疼痛强度、PACU 中止吐剂的使用以及住院时间。我们使用基于倾向评分的最接近匹配（1：3的比例）来平衡患者基线特征。133名患者接受美沙酮治疗，2192名患者接受短效阿片类药物治疗。分析表明，通过口服吗啡当量测量，美沙酮与显着降低术中和术后阿片类药物消耗量以及麻醉后护理室中较低的平均疼痛强度评分相关。此外，美沙酮还被证明可以减少手术期间非阿片类镇痛剂的使用。我们的研究表明，美沙酮独特的药理学特性，包括静脉注射时起效短、长效药代动力学和多模式效应，与此相关。更好地管理全乳房切除术后的急性疼痛。版权所有 © 2024 Elsevier Inc. 保留所有权利。

Breast cancer is the most frequent type of cancer and the second leading cause of cancer-related mortality in women. Mastectomies remain a key component of the treatment of non-metastatic breast cancer, and strategies to treat acute postoperative pain, a complication affecting nearly all patients undergoing surgery, continues to be an important clinical challenge. This study aimed to determine the impact of intraoperative methadone administration compared to conventional short-acting opioids on pain-related perioperative outcomes in women undergoing a mastectomy.This single-center retrospective study included adult women undergoing total mastectomy. The primary outcome of this study was postoperative pain intensity on day 1 after surgery. Secondary outcomes included perioperative opioid consumption, perioperative non-opioid analgesics use, duration of surgery and anesthesia, time to extubation, pain intensity in the postanesthesia care unit (PACU), anti-emetic use in PACU, and length of stay in hospital. We used the propensity score-based nearest matching with a 1:3 ratio to balance the patient baseline characteristics.133 patients received methadone, and 2192 patients were treated with short-acting opioids. The analysis demonstrated that methadone was associated with significantly lower intraoperative and postoperative opioid consumption as measured by oral morphine equivalents and lower average pain intensity scores in the postanesthesia care unit. Moreover, methadone was also shown to reduce the use of non-opioid analgesia during surgery.Our study suggests that the unique pharmacological properties of methadone, including a short onset of action when given intravenously, long-acting pharmacokinetics, and multimodal effects, are associated with better acute pain management after a total mastectomy.Copyright © 2024 Elsevier Inc. All rights reserved.