Skip to main content

Advertisement

SpringerLink
Log in

Perioperative Management of Patients on Buprenorphine: A Literature Review

  • Patient Safety in Anesthesia (SJ Brull and JR Renew, Section Editors)
  • Published:
Current Anesthesiology Reports Aims and scope Submit manuscript

  • 7 Altmetric

Abstract

Purpose of Review

This review summarizes the current practice of perioperative management for patients on long-term buprenorphine (BpN). It aims to elucidate the pharmacological properties of BpN, evaluate the existing literature on perioperative outcomes for patients on BpN, and emphasize the importance of following the current perioperative consensus recommendations when caring for this specific patient population.

Recent Findings

For patients on long-term BpN, the perioperative continuation of their BpN dosage was associated with better postoperative pain control and less opioid consumption. Compared to opioid-agonist naïve patients, patients on BpN were more likely to require additional opioid-agonist medication postoperatively. The opioid need was greater when long-term BpN therapy was discontinued perioperatively. When comparing patients on long-term BpN with other opioid-agonist therapies, most studies found minimal statistical significance in the differences in postoperative pain control and opioid consumption.

Summary

Professional society consensus recommendations and current literature advise the continuation of long-term BpN during the entire perioperative period, emphasizing the benefits of providing multimodal analgesia and suggesting the potential usage of additional full opioid agonists for acute pain management. The multidisciplinary team involves in the care of the patients on long-term BpN should establish a protocol to provide preoperative patient education on the continuation of BpN, deliver perioperative multimodal pain regiments, anticipate higher postoperative analgesic requirements, and recommend outpatient follow-up upon discharge to ensure the best patient outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

No datasets were generated or analyzed during the current study.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Centers for Disease Control and Prevention. Risks and how to reduce them. 2022. https://www.cdc.gov/opioids/patients/reduce-risks.html. Accessed 14 June 2023.

  2. Centers for Disease Control and Prevention. Provisional Data Shows U.S. Drug Overdose Deaths Top 100,000 in 2022. 2023. https://www.cdc. gov/opioids/patients/reduce-risks.html. Accessed 14 June 2023.

  3. Davis MP, Pasternak G, Behm B. Treating chronic pain: an overview of clinical studies centered on the buprenorphine option. Drugs. 2018;78(12):1211–28. https://doi.org/10.1007/s40265-018-0953-z.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Warner NS, Warner MA, Cunningham JL, Gazelka HM, Hooten WM, Kolla BP, et al. A practical approach for the management of the mixed opioid agonist-antagonist buprenorphine during acute pain and surgery. Mayo Clin Proc. 2020;95(6):1253–67. https://doi.org/10.1016/j.mayocp.2019.10.007. Provides a comprehensive review of buprenorphine and its different formulations and highlights management strategies.

    Article  CAS  PubMed  Google Scholar 

  5. Quaye A, Wampole C, Riker RR, Seder DB, Sauer WJ, Richard JM, et al. Buprenorphine continuation during critical illness associated with decreased inpatient opioid use in individuals maintained on buprenorphine for opioid use disorder in a retrospective study. J Clin Pharmacol. 2023; https://doi.org/10.1002/jcph.2286.

  6. Quaye AN, Zhang Y. Perioperative management of buprenorphine: solving the conundrum. Pain Med. 2019;20(7):1395–408. https://doi.org/10.1093/pm/pny217.

    Article  PubMed  Google Scholar 

  7. Gudin J, Fudin J. A narrative pharmacological review of buprenorphine: a unique opioid for the treatment of chronic pain. Pain Ther. 2020;9(1):41–54. https://doi.org/10.1007/s40122-019-00143-6.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Johnson SB, King AJ, Warner EL, Aneja S, Kann BH, Bylund CL. Using ChatGPT to evaluate cancer myths and misconceptions: artificial intelligence and cancer information. JNCI Cancer Spectr. 2023;7(2) https://doi.org/10.1093/jncics/pkad015.

  9. Komatsu R, Nash M, Peperzak KA, Wu J, Dinges EM, Bollag LA. Postoperative pain and opioid dose requirements in patients on sublingual buprenorphine: a retrospective cohort study for comparison between postoperative continuation and discontinuation of buprenorphine. Clin J Pain. 2021;38(2):108–13. https://doi.org/10.1097/AJP.0000000000000996.

    Article  PubMed  Google Scholar 

  10. Li AH, Schmiesing C, Aggarwal AK. Evidence for Continuing Buprenorphine in the Perioperative Period. Clin J Pain. 2020;36(10):764–74. https://doi.org/10.1097/AJP.0000000000000858.

    Article  PubMed  Google Scholar 

  11. Hathaway DB, Bhat JA, Twark C, Rodriguez C, Suzuki J. Patients' experiences with continuation or discontinuation of buprenorphine before painful procedures: a brief report. Am J Addict. 2023;32(4):410–4. https://doi.org/10.1111/ajad.13396.

    Article  PubMed  Google Scholar 

  12. Schuster B, Bell B, Massoll A, White S, Massoll AF. Continuation versus discontinuation of buprenorphine in the perioperative setting: a retrospective study. Cureus. 2022;14(3):e23385. https://doi.org/10.7759/cureus.23385.

  13. Attaar A, Curran M, Meyenburg L, Bottner R, Johnston C, Roberts MK. Perioperative pain management and outcomes in patients who -discontinued or continued pre-existing buprenorphine therapy. J Opioid Manag. 2021;17(7):33–41. https://doi.org/10.5055/jom.2021.0640.

    Article  PubMed  Google Scholar 

  14. Macintyre PE, Russell RA, Usher KA, Gaughwin M, Huxtable CA. Pain relief and opioid requirements in the first 24 hours after surgery in patients taking buprenorphine and methadone opioid substitution therapy. Anaesth Intensive Care. 2013;41(2):222–30. https://doi.org/10.1177/0310057X1304100212.

    Article  CAS  PubMed  Google Scholar 

  15. Martin YN, Deljou A, Weingarten TN, Schroeder DR, Sprung J. Perioperative opioid requirements of patients receiving sublingual buprenorphine-naloxone: a case series. BMC Anesthesiol. 2019;19(1):68. https://doi.org/10.1186/s12871-019-0745-3.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Riddle J, Botsford JA, Dean S, Coffman C, Robinson CA, Kerver JM. Pain management after cesarean delivery among women with opioid use disorder: results from a retrospective pregnancy cohort in a rural region of the Midwest. Womens Health Rep (New Rochelle). 2023;4(1):154–61. https://doi.org/10.1089/whr.2022.0108.

    Article  PubMed  Google Scholar 

  17. Sharp AL, Gilbert S, Perez DN, Kolodzie K, Behrends M. Perioperative outcomes for patients on chronic buprenorphine undergoing spine surgery: a case series. J Opioid Manag. 2021;17(7):171–7. https://doi.org/10.5055/jom.2021.0655.

    Article  PubMed  Google Scholar 

  18. Wyse JJ, Herreid-O'Neill A, Dougherty J, Shull S, Mackey K, Priest KC, et al. Perioperative management of buprenorphine/naloxone in a large, national health care system: a retrospective cohort study. J Gen Intern Med. 2022;37(12):2998–3004. https://doi.org/10.1007/s11606-021-07118-4.

    Article  PubMed  Google Scholar 

  19. Meyer M, Paranya G, Keefer Norris A, Howard D. Intrapartum and postpartum analgesia for women maintained on buprenorphine during pregnancy. Eur J Pain. 2010;14(9):939–43. https://doi.org/10.1016/j.ejpain.2010.03.002.

    Article  CAS  PubMed  Google Scholar 

  20. Cobb J, Craig W, Richard J, Snow E, Turcotte H, Warters R, et al. A retrospective study of acute postoperative pain after cesarean delivery in patients with opioid use disorder treated with opioid agonist pharmacotherapy. J Addict Med. 2022;16(5):549–56. https://doi.org/10.1097/ADM.0000000000000964.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Martin YN, Pearson ACS, Tranchida JR, Weingarten TN, Schulte PJ, Sprung J. Implications of uninterrupted preoperative transdermal buprenorphine use on postoperative pain management. Reg Anesth Pain Med. 2019;44(3):342–7. https://doi.org/10.1136/rapm-2018-100018.

    Article  PubMed  Google Scholar 

  22. Vilkins AL, Bagley SM, Hahn KA, Rojas-Miguez F, Wachman EM, Saia K, et al. Comparison of post-cesarean section opioid analgesic requirements in women with opioid use disorder treated with methadone or buprenorphine. J Addict Med. 2017;11(5):397–401. https://doi.org/10.1097/ADM.0000000000000339.

    Article  CAS  PubMed  Google Scholar 

  23. Reno JL, Kushelev M, Coffman JH, Prasad MR, Meyer AM, Carpenter KM, et al. Post-cesarean delivery analgesic outcomes in patients maintained on methadone and buprenorphine: a retrospective investigation. J Pain Res. 2020;13:3513–24. https://doi.org/10.2147/JPR.S284874.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Dale RC, Metcalf CL, Bockman C, Langford DJ, Fong CT, Peperzak KA. Comparison of PACU length of stay and opioid requirements of patients maintained on buprenorphine or methadone for opioid use disorder. J Opioid Manag. 2022;18(1):7–15. https://doi.org/10.5055/jom.2022.0689.

    Article  PubMed  Google Scholar 

  25. Komatsu R, Nash M, Peperzak KA, Ziga TM, Dinges EM, Delgado C, et al. Comparison between preoperative methadone and buprenorphine use on postoperative opioid requirement: a retrospective cohort study. Clin J Pain. 2022;38(5):311–9. https://doi.org/10.1097/AJP.0000000000001019.

    Article  PubMed  Google Scholar 

  26. Quaye A, Mardmomen N, Mogren G, Ibrahim Y, Richard J, Zhang Y. Current state of perioperative buprenorphine management-a national provider survey. J Addict Med. 2023; https://doi.org/10.1097/ADM.0000000000001191. Provides a nationwide survey about how providers manage patients on buprenorphine.

  27. Cao SS, Dunham SI, Simpson SA. Prescribing buprenorphine for opioid use disorders in the ed: a review of best practices, barriers, and future directions. Open Access Emerg Med. 2020;12:261–74. https://doi.org/10.2147/OAEM.S267416.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kohan L, Potru S, Barreveld AM, Sprintz M, Lane O, Aryal A, et al. Buprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel. Reg Anesth Pain Med. 2021;46(10):840–59. https://doi.org/10.1136/rapm-2021-103007. Most recent consensus regarding buprenorphine, elaborated by a multisociety expert panel.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pain Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA

    Laura Furtado-Pessoa-de-Mendonca, Christine Hunt, Johanna Mosquera-Moscoso, Sebastian Encalada & Jason Eldrige

  2. Library Services, Mayo Clinic, Rochester, MN, USA

    Larry Prokop

  3. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA

    Sher-Lu Pai

Authors
  1. Laura Furtado-Pessoa-de-Mendonca
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christine Hunt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Johanna Mosquera-Moscoso
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sebastian Encalada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Larry Prokop
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sher-Lu Pai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jason Eldrige
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JSE had the idea for the article and guided the overall process. LP conducted the literature search. LFPM, JMM and SE reviewed the search results, applied inclusion criteria and extracted the data. CLH mentored LFPM, JMM and SE during the whole process. LFPM provided the first draft. CLH, SLP and JSE provided intensive revisions to the first draft, and JMM and SE provided additional edits to the final submission. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Laura Furtado-Pessoa-de-Mendonca.

Ethics declarations

Conflict of Interest

CH has received funding from Nevro in support of research, unrelated to this work, paid to her institution.

Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Furtado-Pessoa-de-Mendonca, L., Hunt, C., Mosquera-Moscoso, J. et al. Perioperative Management of Patients on Buprenorphine: A Literature Review. Curr Anesthesiol Rep (2024). https://doi.org/10.1007/s40140-024-00612-5

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40140-024-00612-5

Keywords

Search

Navigation