Purpose: Methadone is a broad-spectrum analgesic with long duration of effect. These properties however make methadone highly appealing in the management of postoperative pain, particularly for patients with complex analgesic requirements. Despite this, there are poorly defined guidelines and protocols surrounding the use of methadone for acute pain, mainly driven by unfamiliarity, lack of consensus data on feasibility and dose titration as well as negative stigma. This case report and literature review explore the efficacious use of methadone and highlights the current challenges and barriers to the implementation of methadone as an analgesia option for chronic pain patients following surgery. Case presentation: We report on an interesting case whereby intravenous methadone was effectively used for postoperative analgesia in a 56-year-old female with complex chronic pain secondary to a mucinous pelvic neoplasm of unclear primary who underwent palliative resection. Methodology: A case report and systematic review was conducted in accordance to the CARE. The patient provided written consent for the de-identification and use of their medical information and data for the generation and publication of this case report. Results and Discussion: Our case report and literature review demonstrate there remains significant heterogeneity, unfamiliarity and scarce use of intravenous methadone in the perioperative and postoperative space in the management of patients with complex pain regimens such as chronic cancer pain patients. Despite this, our case report and literature review highlights as a broad analgesic, intravenous methadone warrants consideration following more rigorous research and development of safe use guidelines into its use for this purpose.