Perioperative Management of Patients on Buprenorphine and Methadone: A Narrative Review

Sritapan, Yasmin; Clifford, Sean P.; Bautista, Alexander

doi:10.4274/balkanmedj.galenos.2020.2020.5.2

Cited by 11 publications

(7 citation statements)

References 50 publications

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“…To this effect, a recent clinical practice advisory states, "it is almost always appropriate to continue buprenorphine at the preoperative dose; furthermore, it is rarely appropriate to reduce the buprenorphine dose" [119]. This is supported by current consensus statements and expert reviews [18,[120][121][122][123][124][125][126][127][128]. Rigorous evidence on postoperative pain management in patients on MAT remains urgently needed to quantify these anecdotal benefits and to compare the effects of available perioperative strategies on patient-centered outcomes [115].…”

Section: Planning For Perioperative Management Of Chronic Long-actingmentioning

confidence: 99%

“…The patient’s usual total daily dose, or a slightly increased total daily dose, is divided into 2 to 4 doses throughout the day starting on the day of surgery. The patient can then be discharged on their usual preoperative regimen without therapy interruption [ 121 , 125 , 128 ]. Alternatively, some have advocated for a buprenorphine dose reduction in the perioperative period if the patient is on higher chronic doses and/or is experiencing inadequate pain relief despite appropriately dosed as-needed opioids, citing the dose-dependent mu opioid receptor antagonism of buprenorphine [ 119 , 122 , 126 , 132 ].…”

Section: Pain Management and Opioid Stewardship Across The Periopementioning

confidence: 99%

“…Abbreviations: DOS = day of surgery, IM = intramuscular, intraop = intraoperative, periop = perioperative, PCA = patient-controlled analgesia, PRN = as needed. References: [ 18 , 116 , 117 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 ].…”

Section: Figurementioning

confidence: 99%

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Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.

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Section: Planning For Perioperative Management Of Chronic Long-actingmentioning

confidence: 99%

Section: Pain Management and Opioid Stewardship Across The Periopementioning

confidence: 99%

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Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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“…Нерідко такі пацієнти приймають бупренорфін або метадон для підтримки та лікування опіоїдної залежності або хронічного болю. В умовах гострого болю оптимальне ведення пацієнтів з розладом вживання опіоїдів є складним завданням [19].…”

Section: анестезіологічні особливості у пацієнтів з опіоїдною залежніCтюunclassified

Perioperative management of patients with drug addiction

Markov

2023

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Background. Patients undergoing surgical or diagnostic procedures, as well as critically ill patients, often suffer from psychoactive substance use disorders. The term “psychoactive substances” here includes both narcotics and psychotropic substances (or their analogs) as well as their precursors. They are strongly associated with drug addiction and such behavioral disorders as addictive behavior and delinquency. People with drug addiction is a high-risk group due to a variety of physical and mental factors. Common comorbidities in this population include human immunodeficiency virus, viral hepatitis, and infections caused by resistant strains of microorganisms. Clinical practice shows that medical professionals often underestimate the likelihood of disorders that occur in such patients before surgery. Generally, disorders related to the abuse of psychoactive substances are treatable, and most pathophysiological changes in organ functions are reversible. Early detection of such disorders and the risks associated with them is crucial for the timely use of the appropriate preventive measures in order to reduce the frequency and severity of these complications. Despite the increased perioperative risk, these patients can be treated safely if multidisciplinary treatment strategies are implemented. Psychoactive substance abuse leads to a wide spectrum of disorders, regardless of whether it is occasional cannabis usage or severe dependence on stimulants or narcotics. This explains the need for a personalized approach from an anesthesiologist to avoid complications associated with the use of cannabinoids, cocaine, amphetamines, or opioids. Therefore, the need for an individual approach to perioperative anesthesiological management with mandatory monitoring and personalized selection of anesthesia techniques and methods is justified. Conclusions. Drug addiction can be successfully managed if it is detected in time by an anesthesiologist during the preoperative period. Knowledge of the main pharmacological effects and clinical signs of prolonged psychoactive substance use in patients allows anesthesiologists to proactively outline the optimal strategy for anesthetic management of such patients during surgical interventions.

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“…Patients on medication-assisted treatment will require that to be managed, generally with continuation throughout the perioperative period (definitely methadone, although buprenorphine is more controversial and with limited evidence). 180,181 Discontinuation of medication-assisted treatment may confer critical risks of return to illicit drug use or overdose. 182 4.…”

Section: Evaluate Patient Preoperative Opioid Usementioning

confidence: 99%

Opioids and Public Health: The Prescription Opioid Ecosystem and Need for Improved Management

2021

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While U.S. opioid prescribing has decreased 38% in the past decade, opioid deaths have increased 300%. This opioid paradox is poorly recognized. Current approaches to opioid management are not working, and new approaches are needed. This article reviews the outcomes and shortcomings of recent U.S. opioid policies and strategies that focus primarily or exclusively on reducing or eliminating opioid prescribing. It introduces concepts of a prescription opioid ecosystem and opioid pool, and it discusses how the pool can be influenced by supply-side, demand-side, and opioid returns factors. It illuminates pressing policy needs for an opioid ecosystem that enables proper opioid stewardship, identifies associated responsibilities, and emphasizes the necessity of making opioid returns as easy and common as opioid prescribing, in order to minimize the size of the opioid pool available for potential diversion, misuse, overdose, and death. Approaches are applicable to opioid prescribing in general, and to opioid prescribing after surgery.

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Perioperative Management of Patients on Buprenorphine and Methadone: A Narrative Review

Cited by 11 publications

References 50 publications

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Perioperative management of patients with drug addiction

Opioids and Public Health: The Prescription Opioid Ecosystem and Need for Improved Management

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