Contributor: Don Stader, MD

Educational Pearls:

Buprenorphine is a partial Mu-agonist and binds with higher affinity than most opioids
Pain management with opioids therefore can be difficult in patients taking buprenorphine
Ketamine is a good option for pain control in these patients
You can also consider using additional buprenorphine
Intravenous buprenorphine is dosed differently than oral formulations
Consider receptor availability - patients on high doses of buprenorphine (32mg) will have few Mu receptors available, and thus will likely not benefit from opiate pain meds of any kind

References

Alford DP, Compton P, Samet JH. Acute pain management for patients receiving maintenance methadone or buprenorphine therapy. Ann Intern Med. 2006;144(2):127–134.

Summarized by Will Dewispelaere, MS3 | Edited by Erik Verzemnieks, MD

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