Guidelines for the use of buprenorphine for opioid use disorder in the perioperative setting

Kohan, Lynn; Potru, Sudheer; Barreveld, Antje M.; Sprintz, Michael; Lane, Olabisi; Aryal, Anuj; Emerick, Trent; Dopp, Anna Legreid; Chhay, Sophia; Viscusi, Eugene R.

doi:10.1136/rapm-2021-103092

Cited by 8 publications

(22 citation statements)

References 3 publications

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“…A patient-centered approach investing in shared decision-making and expectations is essential to all MOUD strategies when managing acute surgical pain. Prevailing consensus-based recommendations 2 advise continuation of methadone and buprenorphine MOUD without interruption throughout the perioperative period. Secondary to its µ-opioid receptor antagonism, naltrexone dosed for OUD treatment (in contrast to low-dose naltrexone for treating chronic pain) may need to be discontinued before surgery if acute opioid dosing is anticipated.…”

Section: Perioperative Considerations For Patients Prescribed Moudmentioning

confidence: 99%

“…Prospective studies on the optimal perioperative buprenorphine dosing are lacking and informed primarily by case reports and consensus-based protocols. Kohan et al 2 in 2021 released multisociety expert recommendations regarding buprenorphine in the perioperative period. Although there is debate about opioid receptor availability with higher doses of buprenorphine, home dose buprenorphine is recommended to be continued before surgery, as tapering or discontinuing buprenorphine before surgery may increase the risk of a setback and possible death.…”

Section: Perioperative Considerations For Patients Prescribed Moudmentioning

confidence: 99%

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Caring for Our Patients With Opioid Use Disorder in the Perioperative Period: A Guide for the Anesthesiologist

Barreveld,

Mendelson,

Deiling

et al. 2023

Anesthesia &Amp; Analgesia

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Opioid use disorder (OUD) is a rising public health crisis, impacting millions of individuals and families worldwide. Anesthesiologists can play a key role in improving morbidity and mortality around the time of surgery by informing perioperative teams and guiding evidence-based care and access to life-saving treatment for patients with active OUD or in recovery. This article serves as an educational resource for the anesthesiologist caring for patients with OUD and is the second in a series of articles published in Anesthesia & Analgesia on the anesthetic and analgesic management of patients with substance use disorders. The article is divided into 4 sections: (1) background to OUD, treatment principles, and the anesthesiologist; (2) perioperative considerations for patients prescribed medications for OUD (MOUD); (3) perioperative considerations for patients with active, untreated OUD; and (4) nonopioid and nonpharmacologic principles of multimodal perioperative pain management for patients with untreated, active OUD, or in recovery. The article concludes with a stepwise approach for the anesthesiologist to support OUD treatment and recovery. The anesthesiologist is an important leader of the perioperative team to promote these suggested best practices and help save lives.

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Section: Perioperative Considerations For Patients Prescribed Moudmentioning

confidence: 99%

Section: Perioperative Considerations For Patients Prescribed Moudmentioning

confidence: 99%

Caring for Our Patients With Opioid Use Disorder in the Perioperative Period: A Guide for the Anesthesiologist

Barreveld,

Mendelson,

Deiling

et al. 2023

Anesthesia &Amp; Analgesia

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“…7,8 A recent multidisciplinary workgroup suggested that there was a moderate level of evidence that patients on buprenorphine should be continued at their home dose during the preoperative period and that multimodal analgesia including short-acting full agonist opioids could be used during the postoperative phase. 9 Within the pregnant population, Meyer et al compared postpartum pain control and opioid utilization following vaginal and cesarean deliveries and found no differences in intrapartum pain or analgesic utilization between patients prescribed buprenorphine and their matched controls that were not on medications for OUD (MOUD). 10 However, those undergoing cesarean section deliveries (19 women) experienced more postpartum pain and required 47% more opioid analgesics than their matched controls.…”

Section: Substance Abuse: Research and Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Peripartum and Postpartum Analgesia and Pain in Women Prescribed Buprenorphine for Opioid Use Disorder Who Deliver by Cesarean Section

et al. 2022

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Aim: Little is known about whether pain can be effectively managed in pregnant women with opioid use disorder (OUD) during delivery hospitalization, particularly those undergoing surgery and taking buprenorphine as medication for OUD (MOUD). To address this question, we compared pain scores and opioid analgesic utilization during delivery hospitalization in women taking their pre-hospital dose of buprenorphine who delivered by cesarean section to matched controls. To inform future research efforts, we also began to explore opioid analgesic utilization and pain scores by type of anesthesia as this variable is often not included in related literature. Methods: Retrospective matched cohort study of 46 women prescribed buprenorphine during pregnancy who delivered by cesarean section during a 7-year period. Results: When compared to matched controls, women taking their pre-hospital dose of buprenorphine undergoing cesarean section utilized more opioid analgesics as measured by morphine milligram equivalents (MME) (mean MME first 48 hours 153.0 mg vs 175.1 mg, respectively, P < .01) but had similar pain scores during delivery hospitalization. There was no difference in MME utilization by maternal dose of buprenorphine though sample sizes were small. Women on buprenorphine who received spinal anesthesia with morphine had mean pain scores that were 1.4 points lower ( P = .01) during the first 48 hours than women on buprenorphine receiving other methods of anesthesia. Discussion And Conclusions: Pregnant women taking their pre-hospital dose of buprenorphine throughout their surgical delivery hospitalization were able to achieve pain relief similar to women not on MOUD but had higher MME requirements. Our results add to the emerging body of evidence suggesting that individuals on MOUD can achieve adequate post-surgical pain management without adjusting their pre-hospital dose of buprenorphine. Further research is required to fully understand the optimal buprenorphine dosing regimen during surgical hospitalizations. Our results also provide important preliminary evidence that spinal anesthesia containing opioids can be used effectively in individuals with OUD requiring surgical intervention.

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“…For those surgeries where severe pain is anticipated, either dose increases or adjustments in the frequency interval should be considered. For those patients who present for surgery untreated, current recommendations encourage initiating buprenorphine preoperatively [14 ▪▪ ,15].…”

Section: Relevance Of Abuse In the Perioperative Periodmentioning

confidence: 99%

Opioid abuse and perioperative care: a new medical disease

Henshaw

Turner

Khanna

2022

Current Opinion in Anaesthesiology

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Purpose of reviewThis review article aims to describe the perioperative clinical implications of opioid use or opioid use disorder (OUD) and to provide recommendations related to analgesia, anesthesia, and postoperative care for patients with this 'new medical disease'. Recent findingsEvidence suggest that 1 in 4 surgical patients will be using opioids preoperatively. Management of these patients, or those with OUD, can be challenging given their opioid tolerance, hyperalgesia, decreased pain tolerance, and increased pain sensitivity. Therefore, an individualized plan that considers how to manage OUD treatment medications, the risk of relapse, multimodal analgesia, and postoperative monitoring requirements is highly important. Fortunately, recent publications provide both insight and guidance on these topics. Postoperatively, persistent opioid utilization appears higher in patients currently using opioids and even for those with a prior history. Although numerous other adverse outcomes are also associated with opioid use or abuse, some may be modifiable with cessation. SummaryA coordinated, evidence-based, multidisciplinary team approach is critical when caring for patients with OUD to ensure safety, provide adequate analgesia, and reduce the risk of relapse. Enhanced postoperative monitoring, multimodal analgesia, and a plan for preoperative opioid management may help to modify the risks of adverse postoperative outcomes.

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Guidelines for the use of buprenorphine for opioid use disorder in the perioperative setting

Cited by 8 publications

References 3 publications

Caring for Our Patients With Opioid Use Disorder in the Perioperative Period: A Guide for the Anesthesiologist

Caring for Our Patients With Opioid Use Disorder in the Perioperative Period: A Guide for the Anesthesiologist

Peripartum and Postpartum Analgesia and Pain in Women Prescribed Buprenorphine for Opioid Use Disorder Who Deliver by Cesarean Section

Opioid abuse and perioperative care: a new medical disease

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