26: Should buprenorphine be discontinued preoperatively?
Depth of Anesthesia
Sublingual Tablets
When administered orally, bupernorphine has poor bile availability. Sub lingual administration is the preferred way to take it. Other formulations include parental formulation, implants and extended release injections. Heading now into the evidence. We'll start with two studies that dive into some of these claims.
Dr. Tony Anderson, an anesthesiologist at the Stanford University School of Medicine, joins us to discuss the evolving literature and evidence around perioperative management of buprenorphine.
Special thanks to Dr. Ashwini Joshi for her assistance with researching for the episode.
Thanks for listening!
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Music by Stephen Campbell, MD.
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References
Anderson TA, Quaye ANA, Ward EN, Wilens TE, Hilliard PE, Brummett CM. To Stop or Not, That Is the Question: Acute Pain Management for the Patient on Chronic Buprenorphine. Anesthesiology. 2017 Jun;126(6):1180-1186. doi: 10.1097/ALN.0000000000001633. PMID: 28511196; PMCID: PMC7041233.
Goel A, Azargive S, Lamba W, Bordman J, Englesakis M, Srikandarajah S, Ladha K, Di Renna T, Shanthanna H, Duggan S, Peng P, Hanlon J, Clarke H. The perioperative patient on buprenorphine: a systematic review of perioperative management strategies and patient outcomes. Can J Anaesth. 2019 Feb;66(2):201-217. English. doi: 10.1007/s12630-018-1255-3. Epub 2018 Nov 27. PMID: 30484167.
Goel A, Azargive S, Weissman JS, Shanthanna H, Hanlon JG, Samman B, Dominicis M, Ladha KS, Lamba W, Duggan S, Di Renna T, Peng P, Wong C, Sinha A, Eipe N, Martell D, Intrater H, MacDougall P, Kwofie K, St-Jean M, Rashiq S, Van Camp K, Flamer D, Satok-Wolman M, Clarke H. Perioperative Pain and Addiction Interdisciplinary Network (PAIN) clinical practice advisory for perioperative management of buprenorphine: results of a modified Delphi process. Br J Anaesth. 2019 Aug;123(2):e333-e342. doi: 10.1016/j.bja.2019.03.044. Epub 2019 May 29. PMID: 31153631; PMCID: PMC6676043.
Hansen LE, Stone GE, Matson CA, Tybor DJ, Pevear ME, Smith EL. Total joint arthroplasty in patients taking methadone or buprenorphine/naloxone preoperatively for prior heroin addiction: a prospective matched cohort study. J Arthroplasty 2016; 31: 1698-701. (29)
Höflich AS, Langer M, Jagsch R, Bäwert A, Winklbaur B, Fischer G, Unger A. Peripartum pain management in opioid dependent women. Eur J Pain. 2012 Apr;16(4):574-84. doi: 10.1016/j.ejpain.2011.08.008. PMID: 22396085; PMCID: PMC3290684.
Li A, Schmiesing C, Aggarwal AK.Evidence for Continuing Buprenorphine in the Perioperative Period. Clin J Pain. 2020 Oct; 36(10): 764-774.doi: 10.1097/AJP.0000000000000858. PMID: 32520814
Macintyre PE, Russel RA, Usher KA, Gaughwin M, Huxtable CA. Pain relief and opioid requirements in the first 24 hours after surgery in patients taking buprenorphine and methadone opioid substitution therapy. Anaesth Intensive Care 2013; 41: 222-30 (27)
Meyer M, Paranya G, Keefer Norris A, Howard D. Intrapartum and postpartum analgesia for women maintained on buprenorphine during pregnancy. Eur J Pain. 2010 Oct;14(9):939-43. doi: 10.1016/j.ejpain.2010.03.002. Epub 2010 May 4. PMID: 20444630.
Quaye A, Potter K, Roth S, Acampora G, Mao J, Zhang Y. Perioperative Continuation of Buprenorphine at Low-Moderate Doses Was Associated with Lower Postoperative Pain Scores and Decreased Outpatient Opioid Dispensing Compared with Buprenorphine Discontinuation. Pain Med. 2020 Sep 1;21(9):1955-1960. doi: 10.1093/pm/pnaa020. PMID: 32167541.
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