Comparison Between Preoperative Methadone and Buprenorphine Use on Postoperative Opioid Requirement

Abstract

Objectives: Buprenorphine is a partial agonist at mu-opioid receptors and competes for these receptors with other opioids in vitro. Whether patients on buprenorphine maintenance require high doses of opioid analgesics to attain adequate postoperative pain control has not been determined. We evaluated differences in acute postoperative opioid consumption and pain burden between patients taking buprenorphine and those taking methadone preoperatively. Materials and Methods:A retrospective review of medical records of 928 patients, of whom 195 were on buprenorphine and 733 were on methadone preoperatively, was performed. Among methadone and buprenorphine patients, 615 and 89, respectively, continued to receive the medications postoperatively. Buprenorphine patients were compared with methadone patients for the first 48 hours postoperatively with regard to acute opioid dose requirements (morphine milligram equivalents [MME] above their baseline buprenorphine and methadone doses) and time-weighted average (TWA) pain scores (using targeted maximum likelihood estimation).Results: Opioid dose requirements for 48 hours postoperatively were 150 (22 to 297) (median [interquartile range]) and 220 [90 to 360] MME for buprenorphine and methadone patients, respectively. Preoperative buprenorphine was associated with a 59.9% lower postoperative MME (95% confidence interval: 46.6%-69.8%, P < 0.0001) compared with methadone. Postoperative TWA pain scores for the first 48 hours were 5.0 ± 2.7 (mean ± SD), and 5.4 ± 2.3 for buprenorphine and methadone patients, respectively. Preoperative buprenorphine was associated with a 0.37-point lower TWA pain score (95% confidence interval: 0.14-0.61, P = 0.002) compared with methadone.Discussion: Preoperative buprenorphine use was associated with > 50% reduction in postoperative opioid dose requirement and a statistically significant, though clinically unimportant, reduction in acute pain burden in comparison to methadone. The study is limited by several important factors such as the exclusion of patients requiring intravenous patient-controlled analgesia, small number of patients were on higher dose of buprenorphine, and a large percentage of methadone patients were not on a stable dose of methadone yet.

Association Between Postoperative Methocarbamol and Postoperative Pain Opioid Dose Requirements

“…In our previous study of the surgical population at UWMC and HMC, the SD of TWA pain score during 48 hours postoperatively was 2.7 or smaller. 9 Assuming SD of 2.7 for TWA pain scores in both methocarbamol and non-methocarbamol groups, sample size estimation before the study confirmed a sample size of ∼700 methocarbamol patients and ∼8000 non-methocarbamol patients would provide 80% power to detect a difference of 0.3 in the TWA pain scores between methocarbamol and non-methocarbamol groups based on a t-test. Stata/SE version 17 (Stata-Corp LLC, Houston, Texas) was used for all statistical analyses.…”

Effects of a Two-Month Exercise Training Program on Concurrent Non-Opiate Substance Use in Opioid-Dependent Patients during Substitution Treatment

“…It has been reported that people with opioid use disorders are interested in exercising as part of their treatment to reduce their desire for substance use and improve their overall physical and mental health [76]. Moreover, those patients prefer to start an exercise program early in their recovery (i.e., in the first 3 months) [77][78][79].…”

Diels–Alder Adducts of Morphinan-6,8-Dienes and Their Transformations

“…Current pharmacological approaches for the treatment of opioid addiction emphasize replacement with partial agonists such as methadone or buprenorphine [318], sometimes in conjunction with the antagonist naloxone [319]. Despite its partial agonist action, buprenorphine is an effective analgesic [320], as is methadone, albeit to a lesser extent [321]. In consideration of all these issues, the search for a "magic bullet", that is to say, an opioid agonist that relieves pain without having abuse potential may seem a quixotic ambition.…”

“…In 2000, Derrick et al [228] reported the syntheses of cinnamoyl derivatives of both 7α-amino-N 17 -cyclopropylmethyl-(324a) and 7α-aminomethyl-N 17 -cyclopropylmethyl-6,14ethenomorphinans (324b, Figure 84). For the synthesis of the 7α-amino derivate (324a), N 17 -cyclopropylmethyl-northevinone (310) was converted in a Schmitt reaction to the 7αacetaminoamino compound, which was hydrolyzed to the 7α-amino-N 17 -cyclopropylmethyl derivative (321). Saturation of the ∆ 18,19 double bond (H 2 /Pd-C, 2 bar) and 3-O-demethylation with KOH gave compound 322.…”