Methadone and Anaesthesia: Sleeping with a Friend or an Enemy?

Methadone is re-emerging as one of the most discussed opioids in modern perioperative medicine. In a recent ADVANCE session, clinicians explored its evolving role in perioperative analgesia, examining both the growing evidence base and the concerns that continue to shape clinical practice. The discussion included interview insights from Professor Evan Kharasch and perspectives from authors involved in recent comprehensive updates on intraoperative methadone. Together, these expert viewpoints highlighted the unique pharmacology of methadone and the ongoing debates surrounding dosing, respiratory safety, drug interactions and patient selection.

A central theme of the discussion was the striking variation in how methadone is used across institutions. While some centres have incorporated it into routine perioperative analgesia strategies, others remain cautious due to uncertainty about optimal dosing and monitoring. Through expert commentary and clinician polling, ADVANCE explored how anaesthetists interpret emerging evidence and navigate these controversies in real-world practice.