Effectiveness of full agonist opioids in patients stabilized on buprenorphine undergoing major surgery: a case series

A review of the medical literature failed to reveal clear, agreed-upon guidelines for practitioners on the postoperative provision of full agonist opioids for patients maintained on buprenorphine. Some controversy appears to exist about whether to maintain patients on their buprenorphine regimen up to the time of surgery. We describe the surgical outcomes and pain assessments for a series of five patients who underwent seven major surgical procedures. The patients were maintained on stable doses of sublingual buprenorphine. Postoperative pain was adequately controlled using full agonist opioids according to self-report and physician assessment. The observations from this case series lend support to the practice of maintaining stable buprenorphine dosing for patients who require major surgery.