Murphy GS, Avram MJ, Greenberg SB, et al. - Researchers sought to test the primary hypothesis that less hydromorphone would be required on the first postoperative day among patients recovering from spinal fusion surgery who are given ketamine and methadone vs those given methadone alone. They conducted a randomized, double-blind, placebo-controlled trial randomizing 130 spinal surgery patients to receive either methadone at 0.2 mg/kg (ideal body weight) intraoperatively and a 5% dextrose in water infusion for 48 h postoperatively (methadone group) or 0.2 mg/kg methadone intraoperatively and a ketamine infusion (0.3 mg · kg ⁻¹ · h ⁻¹ infusion [no bolus] intraoperatively and then 0.1 mg · kg ⁻¹ · h ⁻¹ for next 48 h [both medications dosed at ideal body weight]; methadone/ketamine group). Per outcomes, pain scores were reduced from 4 to 2 points on an 11-point Likert scale and postoperative opioid use roughly halved in correlation with adding ketamine to methadone. In patients recovering from spine surgery, consideration could be given to adding low-dose ketamine to methadone as it improves analgesia and reduces opioid requirement.