Methadone Analgesia During Awake Craniotomy for a Patient With Chronic Pain on Buprenorphine: A Case Report

The resection of brain tumors requires careful surgical and anesthetic planning to preserve essential motor, cognitive, and sensory cortical regions. An awake craniotomy with stereotactic brain mapping is frequently performed to protect these areas, requiring patients to be conscious enough for functional and neurocognitive testing. Patients on long-term opioids for chronic pain present unique anesthetic challenges, requiring anesthesiologists to balance providing adequate analgesia with maintaining adequate responsiveness. This case report illustrates the successful use of methadone in the anesthetic management of a patient with chronic pain on transdermal buprenorphine who underwent an awake craniotomy with an asleep-awake technique.