Perioperative Management of Buprenorphine at an Urban Academic Medical Center

• Published in: The Journal of surgical research Vol. 302; pp. 160 - 165
• Main Authors: Brighton, Tessa, Bagchi, Avilash, Fernandez, Juliet, Ashton, Suzanne, Angaramo, Gustavo, Ha, Michael
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2024
• Subjects: Acute pain; Analgesia; Buprenorphine; Opioid use disorder; Perioperative; Analgesia; Perioperative; Acute pain; Buprenorphine; Opioid use disorder
• ISSN: 0022-4804; 1095-8673; 1095-8673
• DOI: 10.1016/j.jss.2024.06.024

Buprenorphine is a partial mu opioid receptor agonist with high affinity to its receptor, which raises concerns of blocking or displacing full opioid agonists when used during the perioperative period of surgical patients. However, buprenorphine itself has high analgesic potency and discontinuing buprenorphine may lead to suboptimal pain control and risk for opioid use disorder relapse. There is limited data for the continuation of buprenorphine perioperatively. This study is a retrospective cohort study of adult surgical patients taking buprenorphine for opioid use disorder at an urban, teaching, level 1 trauma center. Patients were split into two groups based on whether buprenorphine was continued (n = 46) or held (n = 28) within the first 48 h after surgery. Those who had buprenorphine continued in the first 48 h postoperatively required half the dose of nonbuprenorphine opioids compared to those who had buprenorphine held (113.25 versus 255.75 oral morphine equivalents, P = 0.0040). Both groups had a similar level of analgesia and incidence of adverse events. Nearly all patients who continued buprenorphine in the first 48 h postoperatively were discharged on this agent, while only half of patients who had buprenorphine held were restarted on it at discharge (92.68% versus 56.52%, P = 0.0013). This present study found lower nonbuprenorphine opioid requirements in patients with continued versus held perioperative buprenorphine use with no difference in degree of analgesia. •Buprenorphine is a partial mu opioid agonist used to treat opioid use disorder.•Continuing this agent perioperatively was associated with lower opioid requirements.•This was not associated with higher pain scores or adverse events.•Buprenorphine may be appropriate to continue during periods of acute pain.