Perioperative Management of Patients on Buprenorphine: A Literature Review

Purpose of Review This review summarizes the current practice of perioperative management for patients on long-term buprenorphine (BpN). It aims to elucidate the pharmacological properties of BpN, evaluate the existing literature on perioperative outcomes for patients on BpN, and emphasize the importance of following the current perioperative consensus recommendations when caring for this specific patient population. Recent Findings For patients on long-term BpN, the perioperative continuation of their BpN dosage was associated with better postoperative pain control and less opioid consumption. Compared to opioid-agonist naïve patients, patients on BpN were more likely to require additional opioid-agonist medication postoperatively. The opioid need was greater when long-term BpN therapy was discontinued perioperatively. When comparing patients on long-term BpN with other opioid-agonist therapies, most studies found minimal statistical significance in the differences in postoperative pain control and opioid consumption. Summary Professional society consensus recommendations and current literature advise the continuation of long-term BpN during the entire perioperative period, emphasizing the benefits of providing multimodal analgesia and suggesting the potential usage of additional full opioid agonists for acute pain management. The multidisciplinary team involves in the care of the patients on long-term BpN should establish a protocol to provide preoperative patient education on the continuation of BpN, deliver perioperative multimodal pain regiments, anticipate higher postoperative analgesic requirements, and recommend outpatient follow-up upon discharge to ensure the best patient outcomes.