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Facing Pain: Intraoperative Methadone For Facial Feminization Surgery
Sydney Barone, BA1, Stephanie Rothberg, BA
2, Emily Orsino, BS
2, Ashley Howell, BS
2, Charles H. Thorne, MD
1, Priscilla Nelson, MD
3, Nicholas Bastidas, MD
1.
1Division of Plastic and Reconstructive Surgery at Northwell Health, New York, NY, USA,
2Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,
3Department of Anesthesiology at Northwell Health, New York, NY, USA.
PURPOSE: Pain after multiprocedural facial feminization surgery (FFS) can be difficult to manage in the transgender population as there is higher incidence of drug use and misuse compared to the general population. This study evaluates the effect of intraoperative methadone, a mu-opioid receptor agonist and NMDA receptor antagonist with selective serotonin reuptake inhibitor (SSRI) properties, on postoperative opioid requirements in patients who underwent FFS.
METHODS: A retrospective review of patients who underwent FFS between June 2023 and September 2025 was conducted. All patients underwent full- or near-full FFS including at least two separate areas of the face (forehead, nose, and chin and/or mandibular angles). Patients received either 20mg of methadone or standard short-acting opioids intraoperatively. 24-hour postoperative opioid requirements were assessed as oral morphine milligram equivalents (OMME). Average OMME between the methadone and non-methadone cohorts were compared using a two-sample t-test.
RESULTS: 100 patients were included in this study. 50 patients received methadone and 50 patients received standard short-acting opioids intraoperatively. Postoperative OMME ranged from 0 to 91.5 in both groups. Average 24-hour postoperative OMME was significantly lower for the methadone cohort (mean 23.34, SD 23.04) than the non-methadone cohort (mean 39.33, SD 23.35) (p = 0.0008).
CONCLUSION: A single dose of intraoperative methadone during FFS provides analgesia intraoperatively and significantly lowers opioid use over the following 24 hours. Methadone may reduce the need for frequent redosing of short-acting opioids. It should be considered as part of a multimodal regimen to treat pain in the transgender population.
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