Continuous Perioperative Sublingual Buprenorphine

Area of Science:

• Pharmacology
• Anesthesiology
• Pain Management

Background:

• Buprenorphine, a unique opioid, exhibits complex pharmacology with partial mu-agonist and antagonist activities at other receptors.
• Current surgical guidelines often recommend discontinuing buprenorphine 48-72 hours preoperatively due to misconceptions about its analgesic potency and interactions.

Observation:

• A case study compared two surgical courses in the same patient, one with perioperative buprenorphine and one without.
• The patient experienced better pain control and functional recovery when buprenorphine was continued throughout the perioperative period.

Findings:

• Maintaining buprenorphine perioperatively facilitated superior pain management compared to preoperative full mu-agonist opioid use.
• This finding contradicts existing literature and practice guidelines that suggest buprenorphine cessation is necessary.

Implications:

• Perioperative buprenorphine may provide enhanced analgesia and support recovery, particularly for patients with opioid dependency.
• Revisiting current guidelines on perioperative buprenorphine management is warranted based on emerging evidence and clinical observations.