Implications of uninterrupted preoperative transdermal buprenorphine use on postoperative pain management

Martin, Yvette N.; Pearson, Amy C.S.; Tranchida, John R; Weingarten, Toby N.; Schulte, Phillip J.; Šprung, Juraj

doi:10.1136/rapm-2018-100018

Cited by 11 publications

(8 citation statements)

References 24 publications

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“…Receptor studies by Greenwald et al33 showed opioid receptor availability of 100% with 0 mg, 59% with 2 mg, 20% with 16 mg, and 16% with 32 mg of daily buprenorphine. It is noteworthy that the required perioperative opioid doses may be substantially higher in this population than opioid-naive patients and require close attention for titration 34. In summary, there is no universal approach for all patients on buprenorphine.…”

Section: Buprenorphinementioning

confidence: 98%

Optimization of patients with chronic pain and previous opioid use disorders

Chung

Sweitzer

2021

International Anesthesiology Clinics

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Patients have myriad reasons to be concerned about an upcoming surgery. It can be fear of an endotracheal tube or a preoccupation about the likelihood of surgical success. Chief among preoperative concerns is the pain that they may experience both acutely and months later. Although some procedures are associated with only mild discomfort, the majority involve pain that will require an analgesic. 1 Evidence shows that less than half of patients report adequate pain relief after surgery. For example, in a US national survey conducted in 2013, Gan et al 2 reported that of 300 participants who experienced acute postsurgical pain (APSP), 75% had moderate/extreme pain during the immediate postsurgical period, with 74% still experiencing these levels of pain after discharge. Of the ~40 million surgeries that are performed every year, estimates show that 10% to 15% of patients continue to experience chronic pain 1 year after surgery. 3 These numbers vary by the type of surgery performed. The prevalence is particularly high for operations such as mastectomy, inguinal hernia repair, and amputation. 4

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Section: Buprenorphinementioning

confidence: 98%

Optimization of patients with chronic pain and previous opioid use disorders

Chung

Sweitzer

2021

International Anesthesiology Clinics

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“…Traditional teaching and most of the published literature describes a phenomenon suggesting that acute pain control is difficult for patients continued on buprenorphine therapy perioperatively or during other acute pain states. 11,[30][31][32][33] Given that buprenorphine has such high-affinity for mu-opioid receptors, traditional mu-opioid agonists (eg, morphine, fentanyl, hydromorphone, and oxycodone) are blocked from the binding necessary to facilitate adequate analgesia. The solution, in most published algorithms, has been to consider discontinuation of buprenorphine during acute pain states or before major surgery that is at least moderate in anticipated pain severity.…”

Section: Challenges Of Acute Pain Management With Buprenorphinementioning

confidence: 99%

A Practical Approach for the Management of the Mixed Opioid Agonist-Antagonist Buprenorphine During Acute Pain and Surgery

Warner

Cunningham

et al. 2020

Mayo Clinic Proceedings

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The use of buprenorphine, a mixed opioid agonist-antagonist, for the management of chronic pain and/or opioid use disorder is increasing. As such, medical providers will more frequently encounter patients on this therapy. In this paper, we synthesize existing knowledge (derived through keyword searches using MEDLINE databases) in a novel conceptual framework for patients on buprenorphine presenting with acute pain or for those requiring surgical or invasive procedures. This framework is based on three unique domains: the patient, the features of the acute pain insult, and the environment. We discuss important considerations regarding the unique aspects of buprenorphine formulations and dosing, and we describe the importance of multidisciplinary planning and multimodal analgesic strategies. We also highlight important differences in management strategies based upon the presence or absence of opioid use disorder. All medical providers must be prepared to guide the patient on buprenorphine safely through the acute care episode, which includes adequate treatment of acute pain and avoidance of iatrogenic harm, including both short-term complications (eg, respiratory depression) and long-term complications (eg, relapse to opioid use).

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“…Despite the fact that transdermal buprenorphine patch (TBP) is usually prescribed for the management of chronic pain, only a handful of studies have been conducted regarding its preoperative administration as part of PA. A recent prospective study including 50 patients undergoing total joint arthroplasty has reported that the use of a 10-mg TBP dose reduced the postoperative pain, which in turn reduced the number of postoperative analgesics consumed [23]. On the other hand, a different retrospective study showed that patients who used uninterrupted TBP preoperatively required more opioid analgesics after the surgery; however, this study had many limitations, including a lack of documentation regarding postoperative pain scores [24]. More studies are definitely required to fully determine the efficacy of TBPs.…”

Section: Preoperative Application Of Buprenorphine Transdermal Pmentioning

confidence: 99%

Perioperative Pain Management in Patients Undergoing Total Hip Arthroplasty: Where Do We Currently Stand?

Tsinaslanidis

Mahajan

2020

Cureus

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Total Hip replacement (THR) is a well-discussed topic, and it offers excellent results in patients suffering from end-stage osteoarthritis (OA). However, despite the fact that patients can fully bear weight immediately after the surgery, THR is often associated with a great amount of postoperative pain affecting recovery and rehabilitation. Therefore, the efficient management of pain is of paramount importance. The aim of this review is to examine all the currently available strategies of pain management such as preemptive analgesia (PA), patient-controlled analgesia (PCA), and the various types of anesthesia that are used during the operation. With that objective in mind, we conducted our research by searching through the PubMed database for articles published in 2015 and after. For purely clinical reasons, we have attempted to classify all the best available evidence into three major categories: prior to surgery, during the surgery, and after the surgery. Multimodal analgesia seems to play a major role in the perioperative care of patients undergoing total hip arthroplasty (THA). Therefore, a considerable number of studies have been conducted analyzing all the current strategies that aim to minimize perioperative pain and consequent complications.

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Implications of uninterrupted preoperative transdermal buprenorphine use on postoperative pain management

Cited by 11 publications

References 24 publications

Optimization of patients with chronic pain and previous opioid use disorders

Optimization of patients with chronic pain and previous opioid use disorders

A Practical Approach for the Management of the Mixed Opioid Agonist-Antagonist Buprenorphine During Acute Pain and Surgery

Perioperative Pain Management in Patients Undergoing Total Hip Arthroplasty: Where Do We Currently Stand?

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