Perioperative Buprenorphine Management: A Multidisciplinary Approach

Thomas Hickey; Audrey Abelleira; Gregory Acampora; William C Becker; Caroline G Falker; Mitchell Nazario; Melissa B Weimer

doi:10.1016/j.mcna.2021.09.001

Perioperative Buprenorphine Management: A Multidisciplinary Approach

Med Clin North Am. 2022 Jan;106(1):169-185. doi: 10.1016/j.mcna.2021.09.001.

Authors

Thomas Hickey¹, Audrey Abelleira², Gregory Acampora³, William C Becker⁴, Caroline G Falker², Mitchell Nazario⁵, Melissa B Weimer⁶

Affiliations

¹ VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA; Department of Anesthesiology, Yale School of Medicine, 950 Campbell Avenue, West Haven, CT 06516, USA. Electronic address: thomas_hickey@post.harvard.edu.
² VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA.
³ MGH/Harvard Center for Addiction Medicine, Pain Management Center at MGH, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
⁴ Pain Research, Informatics, Multimorbidities and Education Center, VA Connecticut Healthcare System; Program in Addiction Medicine, Yale School of Medicine.
⁵ National PBM Clinical Program Manager, VHA Pharmacy Benefits Management (12PBM), 1st Avenue - 1 Block North of Cermak (Building 37), Hines, IL 60141, USA.
⁶ Program in Addiction Medicine, Yale School of Medicine; Yale School of Public Health.

PMID: 34823729
DOI: 10.1016/j.mcna.2021.09.001

Abstract

Buprenorphine formulations (including buprenorphine/naloxone) are effective treatments of pain and opioid use disorder (OUD). Historically, perioperative management of patients prescribed buprenorphine involved abstinence from buprenorphine sufficient to allow for unrestricted mu-opioid receptor availability to full agonist opioid (FAO) treatment. Evidence is mounting that a multimodal analgesic strategy, including simultaneous administration of buprenorphine and FAO, nonopioid adjuncts such as acetaminophen and nonsteroidal anti-inflammatory drugs, and regional anesthesia, is a safe and effective perioperative strategy for the patient prescribed long-term buprenorphine treatment of OUD. This strategy will likely simplify management and more seamlessly provide continuous buprenorphine treatment of OUD after hospital discharge.

Keywords: Analgesia; Buprenorphine; Opioid-related disorders; Pain; Partial opioid agonists; Postoperative.

Publication types

Case Reports
Review

MeSH terms

Acetaminophen / administration & dosage
Acetaminophen / therapeutic use
Aged
Analgesics, Non-Narcotic / administration & dosage
Analgesics, Non-Narcotic / therapeutic use
Analgesics, Opioid / administration & dosage
Analgesics, Opioid / pharmacology*
Analgesics, Opioid / therapeutic use
Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Arthroplasty, Replacement, Hip / adverse effects
Arthroplasty, Replacement, Hip / methods
Buprenorphine / administration & dosage
Buprenorphine / pharmacology*
Buprenorphine / therapeutic use
Combined Modality Therapy / methods
Drug Compounding / methods
Female
Humans
Interdisciplinary Communication
Male
Opiate Substitution Treatment / methods*
Opioid-Related Disorders / drug therapy
Pain / drug therapy
Pain Management / methods
Pain, Postoperative / prevention & control*
Perioperative Care / methods*
Receptors, Opioid, mu / drug effects

Substances

Analgesics, Non-Narcotic
Analgesics, Opioid
Anti-Inflammatory Agents, Non-Steroidal
Receptors, Opioid, mu
Acetaminophen
Buprenorphine