BoardsBridgeMethadone Maintenance — Perioperative Anesthetic Management
Continuing, splitting, or holding methadone in the surgical patient on opioid agonist therapy
A patient on methadone maintenance for opioid use disorder should receive their usual daily dose on the day of surgery; supplemental full-mu agonists are added for analgesia, and methadone is reinstituted postoperatively once IV opioid needs resolve.
If you forget
CONTINUE the daily methadone dose on the day of surgery — do NOT withhold.
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Key numbers
- Methadone half-life: 8–59 hours (highly variable, longer than analgesic effect)
- QTc threshold: avoid >500 ms; baseline ECG recommended
- Methadone contraindicated in respiratory depression without resuscitative equipment
- No recommended time limit for pharmacological treatment with methadone
- Resume methadone postop when need for IV analgesia has resolved
- Transition buprenorphine → methadone: NO washout period required
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ASAM OUD Focused Update 2020 · ASAM OUD Focused Update 2020 · ASAM OUD Focused Update 2020 · ASAM OUD Focused Update 2020
Re-review cadence: 12 months from reviewed date.
Related on BoardsBridge
Card ID: methadone-maintenance · Path: aba.pain.substance-use-disorders-and-opioid-stewardship.methadone-maintenance