Intraoperative Methadone for the Management of Postoperative Pain in Patients With Head and Neck Cancers

PRIMARY OBJECTIVE: I. To assess the effectiveness of intraoperative methadone compared to control in reducing the requirements of morphine milliequivalents (MMEs). SECONDARY OBJECTIVES: I. To assess the effectiveness of intraoperative methadone compared to control in reducing objective measures of pain, including MMEs, for up to 72 hours postoperatively. II. To assess how soon after surgery patients require additional opioid administration for those in the methadone group compared to control. III. To assess whether additional pain management is required less frequently in the methadone group compared to control. EXPLORATORY OBJECTIVES: I. To assess if there is an increase in the incidence of post-operative emesis events in the methadone group compared to the control. II. To assess the effectiveness of intraoperative methadone compared to control on patient's pain scores daily. III. To assess whether there is a difference in respiratory status between the methadone group compared to the control. IV. To assess whether higher rates of naloxone administration are required in the methadone group. V. To assess if pain control impacted acute recovery more effectively in the methadone group compared to control. VI. Clinical outcomes that are standard of care may be assessed. VII. To assess if there is any impact on pain at \~1 month postoperatively compared to the control group. OUTLINE: Patients are randomized to 1 of 2 arms. ARM I: Patients receive methadone intravenously (IV) at the time of incision during standard of care (SOC) surgery. Patients also receive SOC fentanyl prior to SOC laryngoscopy procedure. ARM II: Patients receive SOC fentanyl prior to SOC laryngoscopy procedure and surgery. After completion of study intervention, patients are followed up at 4-6 weeks.