Perioperative Pain and Addiction Interdisciplinary Network (PAIN): protocol of a practice advisory for the perioperative management of buprenorphine using a modified Delphi process

Abstract

IntroductionThe ongoing opioid epidemic has necessitated increasing prescriptions of buprenorphine, which is an evidence-based treatment for opioid use disorder, and also shown to reduce harms associated with unsafe opioid administration. A systematic review of perioperative management strategies for patients taking buprenorphine concluded that there was little guidance for managing buprenorphine perioperatively. The aim of this project is to develop consensus guidelines on the optimal perioperative management strategies for this group of patients. In this paper, we present the design for a modified Delphi technique that will be used to gain consensus among patients and multidisciplinary experts in addiction, pain, community and perioperative medicine.Methods and analysisA national panel of experts identified by perioperative, pain and/or addiction systematic review authorship established an international profile in perioperative, pain and/or addiction research, community clinical excellence and by peer referral. A steering group will develop the first round with a list of indications to be rated by the panel of national experts, patients and allied healthcare professionals. In round 1, the expert panel will rate the appropriateness of each individual item and provide additional suggestions for revisions, additions or deletions. The definition of consensus will be set a priori. Consensus will be gauged for both appropriateness and inappropriateness of treatment strategies. Where an agreement is not reached and items are suggested for addition/deletion/modification, round 2 will take place over teleconference in order to obtain consensus.Ethics and disseminationInstitutional research ethics board provided a waiver for this modified Delphi protocol. We plan on developing a national guideline for the management of patients taking buprenorphine in the perioperative period that will be generalisable across three sets of preoperative diagnoses including opioid use disorder and/or co-occurring pain disorders. The findings will be published in peer-reviewed publications and conference presentations.

Perioperative Pain and Addiction Interdisciplinary Network (PAIN) clinical practice advisory for perioperative management of buprenorphine: results of a modified Delphi process

“…Further details regarding the formation of the steering committee can be found in the protocol entitled 'The Perioperative Management of Buprenorphine: Protocol for a Modified Delphi Process' by Goel and colleagues (Supplementary Document E2). 12 Expert consensus panel 'Experts' were defined as individuals involved in the management, development, research, teaching, or analysis of clinical perioperative buprenorphine strategies. To identify experts in the field of addiction and perioperative medicine, we reviewed authorship of published guidelines, reviews, and case reports of buprenorphine management in the perioperative period; we identified established profiles in addiction, pain, or perioperative medicine; we solicited peer recommendations from individuals on boards of the National Canadian Society of Addiction Medicine (CSAM), Canadian Pain Society (CPS) and Canadian Anesthesiologist's Society (CAS).…”

“…Further details regarding the selection of the steering committee and the practice advisory development process can be found in the protocol (Supplementary Document E2). 12…”

“…The clinical practice advisory development process is outlined in Figure 1 and was detailed a priori by the steering committee in Supplementary Document E2. 12 Instructions for panellists can be found in Supplementary Document E4. Samples of the Round 1 blinded panel rating forms can be found in Supplementary Documents E5, E6, and E7.…”

Management of opioid use disorder, opioid withdrawal, and opioid overdose prevention in hospitalized adults: A systematic review of existing guidelines

“…With persistent acute pain, nine guidelines recommended escalating to short-acting full agonist opioids at higher doses than used with opioid naïve patients and at shorter intervals. [28][29][30][31][32]34,36,38,48 Guideline recommendations for buprenorphine management in the perioperative period evolved over time. In 2015, the ASAM published practice guidelines, which recommended discontinuation of buprenorphine for OUD in the setting of severe acute pain, which included the perioperative period.…”

Efficacy of multimodal analgesic treatment of severe traumatic acute pain in mice pretreated with chronic high dose of buprenorphine inducing mechanical allodynia

“…However, reduction or even stopping buprenorphine should be differentially considered regarding previous use of buprenorphine for chronic pain treatment or for substance in patients with opioid use disorder(Goel A et al 2019) Anderson et al (2017). suggested to continue buprenorphine in patients undergoing surgeries with only mild pain expected postoperatively, or patients at high risk for perioperative substance abuse relapse, because of the anxiety and possible destabilization caused by the cessation.…”