Methadone for Enhanced Postoperative Analgesia in Intermediate-Risk Noncardiac Surgery (MELODY) (MELODY)
Methadone for Enhanced Postoperative Analgesia in Intermediate-Risk Noncardiac Surgery: A Multicentre Randomized Controlled Trial (MELODY Trial)
Postoperative pain control remains suboptimal for a large proportion of surgical patients and is frequently associated with slower recovery and higher reliance on opioids after surgery. Current intraoperative analgesic approaches predominantly use short-acting opioids, whose rapid pharmacokinetics can lead to variable drug exposure and inconsistent control of nociceptive stimuli.
Methadone has a different pharmacologic profile, combining prolonged μ-opioid receptor activity with N-methyl-D-aspartate receptor antagonism, allowing sustained analgesia following a single intraoperative administration and potentially enhancing postoperative recovery.
The MELODY trial is a multicentre, randomized, patient-blinded clinical study designed to compare a single intravenous dose of methadone given at induction with conventional short-acting opioid-based anesthesia in adults undergoing intermediate-risk noncardiac surgery. The primary aim is to evaluate whether this strategy leads to improved quality of recovery on the first postoperative day.
연구 개요
상태
상세 설명
Acute postoperative pain remains insufficiently controlled in a substantial proportion of surgical patients, with more than half reporting moderate-to-severe pain after surgery. Standard intraoperative opioid strategies rely on short-acting agents such as fentanyl or hydromorphone, which are associated with rapid clearance and fluctuating plasma concentrations that may contribute to variability in nociceptive control and increased postoperative opioid requirements.
Methadone offers a pharmacologic profile that may address these limitations. It provides prolonged analgesic effect due to its long elimination half-life, rapid effect-site equilibration, and additional N-methyl-D-aspartate receptor antagonism, potentially reducing central sensitization and improving postoperative pain control.
The MELODY trial is a multicentre, patient-blinded, randomized, parallel-group superiority trial conducted across University of California hospitals. Participants are randomized in a 1:1 ratio to receive either intravenous methadone at induction or standard short-acting opioid-based anesthesia.
All patients receive a standardized multimodal analgesic regimen to isolate the effect of the intraoperative opioid strategy. The primary outcome is quality of recovery on postoperative day 1, assessed using the validated Quality of Recovery-15 (QoR-15) questionnaire. Secondary outcomes include opioid consumption, pain scores, opioid-related adverse events, and health-related quality of life.
연구 유형
등록 (추정된)
단계
- 3단계
연락처 및 위치
연구 연락처
- 이름: alexandre JOOSTEN, MD PhD
- 전화번호: +13109627337
- 이메일: AJOOSTEN@MEDNET.UCLA.EDU
연구 장소
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California
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Irvine, California, 미국, 92697
- UCI
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연락하다:
- SEAN COECKELENBERGH, MD PhD
- 전화번호: +19496788922
- 이메일: scoeckel@hs.uci.edu
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참여기준
자격 기준
공부할 수 있는 나이
- 성인
- 고령자
건강한 자원 봉사자를 받아들입니다
설명
Inclusion Criteria
- Age ≥18 years
- Elective intermediate-risk noncardiac surgery under general anesthesia
- ASA physical status I-III
- Expected hospital stay ≥24 hours
- Ability to provide informed consent
Exclusion Criteria
- Severe hepatic dysfunction (Child-Pugh C)
- Severe renal impairment (eGFR <30 mL/min/1.73 m²)
- Known allergy to methadone or opioids
- Pregnancy or breastfeeding
- Chronic opioid use or opioid use disorder
- Planned use of epidural or regional analgesia
- Inability to complete study assessments
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 치료
- 할당: 무작위
- 중재 모델: 병렬 할당
- 마스킹: 하나의
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
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실험적: Experimental Arm: Methadone-Based Anesthesia
Intervention: Drug: Methadone Intravenous methadone 0.25 mg/kg (ideal body weight) administered at induction Optional supplemental dose (2 mg) at emergence if clinically indicated Additional intraoperative short-acting opioids discouraged |
Intervention Description - Intravenous Methadone A single intravenous dose of methadone (0.25 mg/kg based on ideal body weight) administered at induction of anesthesia to provide sustained intraoperative and early postoperative analgesia. Additional short-acting opioids are discouraged but may be administered if clinically required. A supplemental dose of methadone (2 mg) may be given at emergence in case of significant nociceptive signs. |
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활성 비교기: Active Comparator Arm: Standard Opioid-Based Anesthesia
Intervention: Drug: Short-acting opioids Fentanyl and/or hydromorphone administered intraoperatively according to clinician judgment Reflects usual care practice |
ntervention Description - Short-acting Opioids Intraoperative analgesia using short-acting opioids (e.g., fentanyl and/or hydromorphone) administered at induction and throughout surgery according to clinician judgment and institutional practice. This approach reflects usual care, with dosing and timing determined pragmatically based on intraoperative needs. |
연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
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Quality of Recovery (QoR-15) score on postoperative day 1
기간: Postoperative Day 1 (24 hours after surgery)
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Quality of recovery assessed using the validated 15-item QoR-15 questionnaire.
Scores range from 0 to 150, with higher scores indicating better recovery.
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Postoperative Day 1 (24 hours after surgery)
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2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
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QoR-15 score on postoperative day 2
기간: Time Frame: Postoperative Day 2
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Time Frame: Postoperative Day 2
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Cumulative opioid consumption (MME)
기간: Time Frame: 0-24 hours and 24-48 hours postoperatively
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Time Frame: 0-24 hours and 24-48 hours postoperatively
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Maximum pain scores (Numeric Rating Scale)
기간: Time Frame: Postoperative day 1 and 2
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Time Frame: Postoperative day 1 and 2
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Opioid-free days
기간: Time Frame: Within 7 days postoperatively
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Time Frame: Within 7 days postoperatively
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Opioid-related adverse events
기간: Time Frame: Up to 48 hours postoperatively
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Includes nausea, vomiting, sedation, respiratory depression
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Time Frame: Up to 48 hours postoperatively
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Health-related quality of life (EQ-5D-5L)
기간: 30 days post-surgery
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The EQ-5D-5L (EuroQol 5-Dimension 5-Level Version) is a health-related quality of life assessment tool that measures quality of life across five dimensions: Mobility: 1 = No problems, 5 = Extreme problems Self-care: 1 = No problems, 5 = Extreme problems Usual activities: 1 = No problems, 5 = Extreme problems Pain/discomfort: 1 = No problems, 5 = Extreme problems Anxiety/depression: 1 = Not at all, 5 = Extremely severe Each dimension is scored on a 5-level scale, allowing for a detailed assessment of health status. |
30 days post-surgery
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공동 작업자 및 조사자
수사관
- 연구 책임자: Joseph Szokol, MD PhD, University of California, Los Angeles
- 연구 책임자: EVAN KARASCH, MD PhD, Duke
연구 기록 날짜
연구 주요 날짜
연구 시작 (추정된)
기본 완료 (추정된)
연구 완료 (추정된)
연구 등록 날짜
최초 제출
QC 기준을 충족하는 최초 제출
처음 게시됨 (실제)
연구 기록 업데이트
마지막 업데이트 게시됨 (실제)
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
추가 정보
이 연구와 관련된 용어
기타 연구 ID 번호
- IRB-25-2394
개별 참가자 데이터(IPD) 계획
개별 참가자 데이터(IPD)를 공유할 계획입니까?
IPD 계획 설명
약물 및 장치 정보, 연구 문서
미국 FDA 규제 의약품 연구
미국 FDA 규제 기기 제품 연구
미국에서 제조되어 미국에서 수출되는 제품
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수술 후 통증에 대한 임상 시험
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Bingol UniversityAtaturk University아직 모집하지 않음수술 전 불안 | 두려움 | PAIN
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Weill Medical College of Cornell UniversityNew York University; National Center for Complementary and Integrative Health (NCCIH)모병
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Istanbul University모병Masticatory Muscle Pain | 근시 통증 증후군 (MP)칠면조
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Istanbul University모병이갈이 | 근막 통증 증후군 | Masticatory Muscle Pain | 현지 근육통터키 (Türkiye)
Intravenous Methadone에 대한 임상 시험
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Grand Shuyang Life Sciences (Chengdu) Co., Ltd.모병
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University of North Carolina, Chapel HillEli Lilly and Company모병