{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T05:54:04Z","timestamp":1773554044170,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH","award":["U01TR003719"],"award-info":[{"award-number":["U01TR003719"]}]},{"name":"NIH","award":["U01HD116257"],"award-info":[{"award-number":["U01HD116257"]}]},{"name":"NIH","award":["R01HD096800"],"award-info":[{"award-number":["R01HD096800"]}]},{"name":"NIH","award":["R01DA054513"],"award-info":[{"award-number":["R01DA054513"]}]},{"name":"NIH","award":["R01DA059321"],"award-info":[{"award-number":["R01DA059321"]}]},{"name":"NIH","award":["R44DA056280"],"award-info":[{"award-number":["R44DA056280"]}]},{"name":"NIH","award":["R43HL167661"],"award-info":[{"award-number":["R43HL167661"]}]},{"name":"NIH","award":["R43DA058430"],"award-info":[{"award-number":["R43DA058430"]}]},{"name":"NIH","award":["R44DA055407"],"award-info":[{"award-number":["R44DA055407"]}]},{"name":"NIH","award":["R41DA059303"],"award-info":[{"award-number":["R41DA059303"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis causes significant postoperative pain and high opioid requirements. Methadone, with dual \u03bc- and \u03ba-opioid agonism and NMDA antagonism, provides long-acting analgesia and may reduce perioperative opioid use. This study evaluated whether perioperative low-dose methadone (0.1 mg\/kg) improves postoperative pain and opioid outcomes after pediatric PSF. Methods: In this single-center retrospective cohort study (January 2019\u2013June 2023), pediatric patients &lt;23 years old undergoing PSF were categorized by perioperative methadone exposure (intraoperative and\/or postoperative) versus no methadone. The primary outcome was total postoperative opioid consumption (morphine milligram equivalents per kilogram, MME\/kg) over postoperative days (POD) 0\u20133. Secondary outcomes were average daily pain scores and hospital length of stay (LOS). Inverse probability weighting (IPW) adjusted for age, sex, and protocol period. Results: A total of 339 patients (51% no methadone, 49% methadone; mean age 14.6 \u00b1 2.5 years; 76% female) were analyzed. Methadone patients had longer anesthesia (392 vs. 372 min, p = 0.042) and surgery times (287 vs. 266 min, p = 0.01). IPW-adjusted associations show postoperative opioid use was significantly higher in the methadone group on POD 0 (median 2.5 vs. 2.1 MME\/kg in no methadone group; p = 0.005). No significant differences were found in postoperative average pain scores (e.g., mean NRS: 2.3 vs. 2.5 on POD 0, p = 0.12) and LOS (3.3 vs. 3.1 days, p = 0.38) between methadone group and no methadone group. Discussion: Perioperative methadone provided similar analgesia for pain management and recovery without prolonging hospitalization, despite higher early opioid use on POD 0. Retrospective design limits causal inference, and residual confounding may persist despite propensity score-based adjustments. Further prospective trials are required to establish safety and dosing. Conclusions: In this retrospective cohort, perioperative low-dose methadone was associated with higher early postoperative opioid use but no significant differences in pain scores or length of stay compared with standard regimens. Methadone did not demonstrate an opioid-sparing effect in this real-world setting. Prospective studies are needed to better define its role and safety in pediatric posterior spinal fusion.<\/jats:p>","DOI":"10.3390\/children13030400","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T08:26:19Z","timestamp":1773390379000},"page":"400","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative Low-Dose Methadone for Pediatric Posterior Spinal Fusion: A Single-Center Retrospective Cohort Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2449-5146","authenticated-orcid":false,"given":"Roshni","family":"Cheema","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, UPMC Children\u2019s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15224, USA"},{"name":"Department of Anesthesia, University of Pittsburgh, Pittsburgh, PA 15260, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristina","family":"Boyd","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, University of Pittsburgh, Pittsburgh, PA 15260, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0933-4536","authenticated-orcid":false,"given":"Mihaela","family":"Visoiu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, UPMC Children\u2019s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8559-9830","authenticated-orcid":false,"given":"Hsing-Hua Sylvia","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA 15224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2355-583X","authenticated-orcid":false,"given":"Scott E.","family":"Licata","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, UPMC Children\u2019s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruth","family":"Ressler","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, UPMC Children\u2019s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15224, USA"},{"name":"Department of Anesthesia, University of Pittsburgh, Pittsburgh, PA 15260, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vishali","family":"Veeramreddy","sequence":"additional","affiliation":[{"name":"School of Medicine, Imperial College London, London SW7 2AZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1420-0524","authenticated-orcid":false,"given":"Shraddha","family":"Sriram","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, University of Pittsburgh, Pittsburgh, PA 15260, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Selena","family":"Rashid","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, UPMC Children\u2019s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3689-8313","authenticated-orcid":false,"given":"Senthilkumar","family":"Sadhasivam","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, UPMC Children\u2019s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, UPMC Children\u2019s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1007\/s00586-021-06817-0","article-title":"Scoliosis and Prognosis\u2014A systematic review regarding patient-specific and radiological predictive factors for curve progression","volume":"30","author":"Lenz","year":"2021","journal-title":"Eur. Spine J."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Chen, L., Sun, Z., He, J., Xu, Y., Li, Z., Zou, Q., and Li, B. (2020). Effectiveness and safety of surgical interventions for treating adolescent idiopathic scoliosis: A Bayesian meta-analysis. BMC Musculoskelet. Disord., 21.","DOI":"10.1186\/s12891-020-03233-1"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1007\/s00381-020-04608-4","article-title":"Current concepts in the diagnosis and management of adolescent idiopathic scoliosis","volume":"36","author":"Addai","year":"2020","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s12178-024-09939-2","article-title":"Adolescent Idiopathic Scoliosis: Advances in Diagnosis and Management","volume":"18","author":"Jinnah","year":"2024","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1097\/CM9.0000000000000652","article-title":"Research progress on the etiology and pathogenesis of adolescent idiopathic scoliosis","volume":"133","author":"Peng","year":"2020","journal-title":"Chin. Med. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s13013-018-0165-z","article-title":"Postoperative pain management in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis: A narrative review","volume":"13","author":"Seki","year":"2018","journal-title":"Scoliosis Spinal Disord."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"105","DOI":"10.4103\/0974-8237.161589","article-title":"Pain management following spinal surgeries: An appraisal of the available options","volume":"6","author":"Bajwa","year":"2015","journal-title":"J. Craniovertebral Junction Spine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1097\/j.pain.0000000000001413","article-title":"The IASP classification of chronic pain for ICD-11: Chronic postsurgical or posttraumatic pain","volume":"160","author":"Schug","year":"2019","journal-title":"Pain"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1213\/ANE.0000000000007351","article-title":"Multi-Institutional Study of Multimodal Analgesia Practice, Pain Trajectories, and Recovery Trends After Spine Fusion for Idiopathic Scoliosis","volume":"141","author":"Einhorn","year":"2025","journal-title":"Anesth. Analg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1213\/ANE.0000000000002458","article-title":"Chronic Opioid Use after Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic","volume":"125","author":"Hah","year":"2017","journal-title":"Anesth. Analg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1016\/j.clinthera.2019.06.003","article-title":"The Impact of the Opioid Epidemic on Children and Adolescents","volume":"41","author":"Winstanley","year":"2019","journal-title":"Clin. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"293","DOI":"10.55275\/JPOSNA-2021-293","article-title":"Postoperative Analgesia After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis","volume":"3","author":"Shah","year":"2021","journal-title":"J. Pediatr. Orthop. Soc. N. Am."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1007\/s40272-020-00423-1","article-title":"Postoperative Pain Management in Pediatric Spinal Fusion Surgery for Idiopathic Scoliosis","volume":"22","author":"Lee","year":"2020","journal-title":"Pediatr. Drugs"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1097\/BPO.0b013e3181b2ba08","article-title":"Epidural Analgesia Compared With Intravenous Analgesia After Pediatric Posterior Spinal Fusion","volume":"29","author":"Gauger","year":"2009","journal-title":"J. Pediatr. Orthop."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1177\/2192568219858308","article-title":"Current Trends in Pediatric Spine Deformity Surgery: Multimodal Pain Management and Rapid Recovery","volume":"10","author":"Shah","year":"2020","journal-title":"Glob. Spine J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1177\/0310057X1003800619","article-title":"A multi-centre multi-national survey of anaesthetists regarding the range of anaesthetic and surgical practices for paediatric scoliosis surgery","volume":"38","author":"Palmer","year":"2010","journal-title":"Anaesth. Intensive Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1007\/s43390-024-00876-1","article-title":"PCA-pump for analgesia following pediatric scoliosis surgery: Bolus administration with\/without basal infusion","volume":"12","author":"Isik","year":"2024","journal-title":"Spine Deform."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1097\/00002508-199303000-00004","article-title":"Pediatric PCA: The Role of Concurrent Opioid Infusions and Nurse-Controlled Analgesia","volume":"9","author":"Weldon","year":"1993","journal-title":"Clin. J. Pain"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1097\/BRS.0000000000001666","article-title":"Accelerated Discharge Protocol for Posterior Spinal Fusion Patients With Adolescent Idiopathic Scoliosis Decreases Hospital Postoperative Charges 22%","volume":"42","author":"Sanders","year":"2017","journal-title":"Spine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1486","DOI":"10.1097\/BRS.0000000000004747","article-title":"Evidence for a Multimodal Pain Management Regimen in Reduction of Postoperative Opioid Use in Pediatric Patients Receiving Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis","volume":"48","author":"Collis","year":"2023","journal-title":"Spine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1080\/17512433.2023.2244417","article-title":"Short-acting versus long-acting opioids for pediatric postoperative pain management","volume":"16","author":"Chen","year":"2023","journal-title":"Expert Rev. Clin. Pharmacol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1007\/s12630-015-0499-4","article-title":"Potential strategies for preventing chronic postoperative pain: A practical approach: Continuing Professional Development","volume":"62","author":"Julien","year":"2015","journal-title":"Can. J. Anesth."},{"key":"ref_23","unstructured":"Cot\u00e9, C.J., Lerman, J., and Anderson, B.J. (2019). 6\u2014Pharmacogenomics. A Practice of Anesthesia for Infants and Children, Elsevier. [6th ed.]. Available online: https:\/\/www.sciencedirect.com\/science\/article\/pii\/B9780323429740000069."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1007\/s00540-020-02887-4","article-title":"Methadone: Applications in pediatric anesthesiology and critical care medicine","volume":"35","author":"Tobias","year":"2021","journal-title":"J. Anesth."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1097\/ALN.0000000000002755","article-title":"Intraoperative Methadone in Surgical Patients: A Review of Clinical Investigations","volume":"131","author":"Murphy","year":"2019","journal-title":"Anesthesiology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1213\/ANE.0000000000005366","article-title":"A Novel Perioperative Multidose Methadone-Based Multimodal Analgesic Strategy in Children Achieved Safe and Low Analgesic Blood Methadone Levels Enabling Opioid-Sparing Sustained Analgesia With Minimal Adverse Effects","volume":"133","author":"Sadhasivam","year":"2021","journal-title":"Anesth. Analg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1111\/pan.14526","article-title":"Scheduled methadone reduces overall opioid requirements after pediatric posterior spinal fusion: A single center retrospective case series","volume":"32","author":"Mok","year":"2022","journal-title":"Pediatr. Anesth."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Blasiole, B., Lavage, D.R., Lin, H.-H.S., Licata, S.E., Sivam, S., Sivam, I., Le, L.M., and Sadha-sivam, S. (2025). Intraoperative Methadone Versus Non-Methadone Analgesia in Pediatric Cardiac Surgery: A Retrospective Cohort Study. Children, 12.","DOI":"10.3390\/children12050567"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.pain.2006.05.006","article-title":"Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents","volume":"125","author":"Stinson","year":"2006","journal-title":"Pain"},{"key":"ref_30","unstructured":"Merkel, S.I., Voepel-Lewis, T., Shayevitz, J.R., and Malviya, S. (1997). The FLACC: A behavioral scale for scoring postoperative pain in young children. Pediatr. Nurs., 23."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1111\/j.1460-9592.1995.tb00242.x","article-title":"CRIES: A new neonatal postoperative pain measurement score. Initial testing of validity and reliability","volume":"5","author":"Krechel","year":"1995","journal-title":"Paediatr. Anaesth."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1111\/pan.14843","article-title":"Perioperative methadone for posterior spinal fusion in adolescents: Results from a double-blind randomized-controlled trial","volume":"34","author":"Fons","year":"2024","journal-title":"Pediatr. Anesth."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/3\/400\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T05:19:59Z","timestamp":1773551999000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/3\/400"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,13]]},"references-count":32,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["children13030400"],"URL":"https:\/\/doi.org\/10.3390\/children13030400","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,13]]}}}