Intraoperative Methadone vs Morphine for Postoperative Pain Control in Patients Undergoing Surgery of the Tibia

Inclusion Criteria: * Subjects scheduled for elective, non-emergent intramedullary nailing (IMN) or open reduction/internal fixation (ORIF) of the tibia at Ben Taub General Hospital * Able to give consent (not cognitively impaired or intoxicated) * Subjects must be 18-50 years of age * American Society of Anesthesiologists (ASA) physical status I-III * Scheduled for primary intramedullary nailing or open reduction/internal fixation of fractures of the tibial shaft or proximal tibia. This must be the first operation for this injured extremity. * Associated fractures of the fibula will be allowed. * Minor lacerations or other associated injuries like "road rash" or open wounds requiring skin graft are permitted Exclusion Criteria: * Subjects who have taken preoperative opioids for more than 7 days before surgery (i.e., tolerant) * Regular use of opioids (whether recreational/illicit or prescribed) within the six months before injury * Subjects who are recommended to receive a regional nerve block or a neuraxial technique (spinal or epidural) by the attending orthopedic surgeon * Subjects who refuse general anesthesia * Subjects deemed to be moderately or severely hypovolemic * External fixator already in place on the injured extremity * Presence of other moderate-to-severe or distracting injuries, such as orthopedic, cervical spine, neurological, intra-abdominal, or intra-thoracic injuries. Minor abrasions/lacerations such as "road rash" or open wounds are acceptable. Associ…