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23rd Annual Pain Medicine Meeting 2024
November 21-23, 2024 | Caesars Palace, Las Vegas, Nevada
6299
THE EFFECTS OF INTRAOPERATIVE METHADONE ON TRANSGENDER AND GENDER-DIVERSE PATIENTS RECEIVING VAGINOPLASTY
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Scientific Abstracts > Acute Pain
The Effects of Intraoperative Methadone on Transgender and Gender-Diverse (TGD) Patients Receiving Vaginoplasty
•Reducing postoperative opioid use is crucial, especially for TGD patients with higher substance use disorder rates1,2,3.
•Effective pain management is key to preventing complications in TGD vaginoplasty.4,5
•Intraoperative methadone reduces opioid use and pain in other surgeries,6,7 but its role in TGD genital surgery is unclear.
•This study aims to explore methadone's effectiveness in TGD vaginoplasty.
•Retrospective cohort study of TGD patients undergoing penile inversion vaginoplasty (Feb 2021 - Sep 2023) at one academic institution.
•Outcomes: total opioid MME consumption, average pain scores (POD 0-3), and incidence of respiratory depression.
•Treatment groups: methadone-only, methadone + SAO, and SAO-only.
•Missing data handled using multiple imputation by chained equations.
•Two-part hurdle models used to address excess zeros:
- Part 1: Logistic regression assessed the odds of opioid use or pain by treatment group.
- Part 2: Linear regression analyzed MME and pain score trends for non-zero cases.
•Controlled for age, race, BMI, alcohol use, smoking, drug use, psychiatric history, SSRI use, diabetes, HIV status, concurrent orchiectomy, length of stay, and substance use history.
•Significance set at p<0.05.
•212 TGD vaginoplasty patients: methadone-only (123), methadone + SAO (50), SAO-only (39).
•No respiratory depression occurred.
•Methadone-only and methadone + SAO groups had lower odds of needing opioids on POD 1, 2, and 3.
•Methadone + SAO group had higher MME on POD0; methadone-only group consumed less MME than SAO-only on POD2.
•Methadone-only and methadone + SAO patients were less likely to report any pain on POD 0-3.
•Patients with pain reported lower scores in the methadone-only and methadone + SAO groups on POD1 and methadone-only on POD2.
•Intraoperative methadone is associated with reduced opioid consumption and lower pain scores in TGD vaginoplasty patients.
•Randomized studies are needed to confirm these findings.
•If confirmed, intraoperative methadone could reduce opioid use, improve outcomes, and support efforts to prevent substance misuse in TGD patients seeking gender-affirming care.