# OPTIMIZING OUTPATIENT ANESTHESIA:  IMPROVING ANALGESIA AND REDUCING OPIOID MISADVENTURE

> **NIH NIH R01** · DUKE UNIVERSITY · 2020 · $559,927

## Abstract

PROJECT SUMMARY/ABSTRACT
The overall long-term objectives of this research are to: (1) reduce the over-prescribing of postoperative
discharge opioids which contribute to the population reservoir of unused pills available for patient misuse, and
for the diversion and misadventure which are contributing to the devastating public health problem of opioid
addiction, overdose, and death; and (2) improve pain treatment, decrease postoperative opioid requirements,
increase patient safety, and diminish opioid-related adverse and side effects after outpatient surgery. Our
research fundamentally challenges long-practiced yet untested notions that opioids of short duration are the
best way to treat surgical pain and to help patients. Anesthesiologists and surgeons face the challenge that
surgical pain is inadequately treated in >80% of patients, 10-50% of whom develop chronic postsurgical pain,
for which acute postoperative pain is the single greatest risk factor. Opioids are the primary pharmacotherapy
for surgical pain, yet with increased use of short-duration opioids, surgical pain treatment has not improved
over the past two decades. In contrast, three decades of clinical research and experience shows that a single
intraoperative dose of a long-duration opioid (i.e. methadone), which sustains therapeutic drug concentrations,
produces better analgesia than repeated doses of short-duration opioids and reduces further opioid
requirements, in inpatient surgery. Nevertheless, in outpatient surgery, methadone has never been evaluated,
and the potential benefits of methadone in outpatient surgery regarding better postoperative pain, side effects,
safety, and reduced opioid consumption remain unrealized. This is a missed opportunity. We will test the
innovative, paradigm-shifting hypothesis that in outpatient surgery, intraoperative anesthesia with methadone,
compared with conventional short-duration opioids, achieves better analgesia, with similar or diminished side
effects, reduces development of chronic postsurgical pain, improves postoperative recovery, and most
importantly, decreases postoperative opioid consumption. Demonstrating reduced opioid consumption and
hence diminishing prescribing of take-home opioids could shrink the population reservoir of unused opioids
available for diversion and misuse, and reduce addiction, overdose, and death. This hypothesis will be tested
in two prospective, randomized, double-blind clinical trials, with separate outpatient cohorts of short-stay
(overnight <24 hours) and same-day surgery. We will compare general anesthesia with single-dose
methadone vs as needed short-duration opioids, evaluate intraoperative and postoperative opioid use, opioid
side effects, short-term and long-term postoperative pain, and overall quality of recovery for up to 1 year.
Successful completion of the aims portends improved outpatient surgical care, enhanced patient recovery, and
reduced postoperative opioid use. An ensuing revolutionary red...

## Key facts

- **NIH application ID:** 9719812
- **Project number:** 5R01DA042985-03
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** Evan D. Kharasch
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $559,927
- **Award type:** 5
- **Project period:** 2018-07-01 → 2021-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9719812

## Citation

> US National Institutes of Health, RePORTER application 9719812, OPTIMIZING OUTPATIENT ANESTHESIA:  IMPROVING ANALGESIA AND REDUCING OPIOID MISADVENTURE (5R01DA042985-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9719812. Licensed CC0.

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