Date of Award
8-14-2026
Document Type
Capstone
Degree Name
Doctor of Nursing Practice (DNP)
School Name
Donna and Allan Lansing School of Nursing and Health Sciences
Department
Nursing
Major Advisor
Dr. Carly Mitchell
Second Advisor
Dr. Chris Webb
Abstract
Abstract
Postoperative pain remains a persistent challenge despite multimodal analgesia and Enhanced Recovery After Surgery (ERAS) protocols. Breakthrough pain and prolonged opioid use can delay recovery, reduce satisfaction, and hinder opioid stewardship. Methadone's long duration of action and N-methyl-D-aspartate (NMDA) receptor antagonism support its role as a perioperative analgesic, yet use remains inconsistent because of knowledge gaps, dosing variability, and safety concerns. This Doctor of Nursing Practice project examined the gap between evidence supporting perioperative methadone and its limited adoption in anesthesia practice, particularly for moderate to complex surgical procedures associated with significant postoperative pain. The project team appraised randomized controlled trials, systematic reviews, and quality improvement studies evaluating analgesic efficacy, opioid-sparing effects, safety, and implementation across surgical specialties. The literature demonstrated that methadone reduced postoperative opioid use and pain scores, improved satisfaction, and did not significantly increase opioid-related adverse events compared with short-acting opioids. Key themes included prolonged analgesia, reduced central sensitization, and alignment with ERAS goals, while inconsistent dosing and limited provider education remained barriers. Based on these findings, a structured educational intervention is proposed for anesthesia providers, focusing on methadone pharmacology, dosing algorithms, contraindications, and monitoring to support safe use within ERAS protocols. Pre- and post-intervention assessments would evaluate changes in provider knowledge, confidence, and early practice trends. An evidence-based methadone education initiative may standardize perioperative analgesia, improve outcomes, and reduce opioid exposure, while strengthening evidence-based anesthesia practice through doctoral-level leadership and quality improvement.
Recommended Citation
Jewell, Frances; Phouvanay, Damon; and Shields, Whitney, "Closing the Knowledge Gap on Perioperative Methadone Use in Enhanced Recovery After Surgery Protocols" (2026). Graduate Theses, Dissertations, and Capstones. 227.
https://scholarworks.bellarmine.edu/tdc/227
Included in
Anesthesiology Commons, Medical Education Commons, Perioperative, Operating Room and Surgical Nursing Commons, Quality Improvement Commons, Surgery Commons