Continuation Versus Discontinuation of Buprenorphine in the Perioperative Setting: A Retrospective Study

Background Buprenorphine use continues to grow for the management of opioid use disorder (OUD) and chronic pain management. In the face of this increase in use, perioperative buprenorphine management continues to have conflicting recommendations with no consensus on optimal management. We examined the effects of holding versus continuing perioperative buprenorphine in patients on chronic buprenorphine therapy to seek an answer to whether it should be continued or discontinued in the perioperative period. Methods Patients who were included in the study had surgery from 2011 to 2020 and had received buprenorphine within 30 days prior to their surgery, were admitted postoperatively for at least 48 hours, went to the postanesthesia care unit (PACU) immediately after surgery, and were successfully extubated. For these 275 patients, the included factors were age, gender, primary surgical service, anesthesia type, postoperative opioid use, preoperative regional block performed, and inpatient pain service (IPS) consultation. The analysis included differences between patients who had continued versus discontinued buprenorphine either preoperatively or postoperatively. Results A total of 275 patients were treated within 30 days of surgery with buprenorphine; of these, 147 (53.4%) patients continued buprenorphine, and 128 (46.6%) discontinued buprenorphine preoperatively. For patients who discontinued buprenorphine preoperatively, the mean days stopped before surgery was 3.5 days. Patients continuing buprenorphine preoperatively had a significantly lower postoperative opioid requirement. In addition, patients were significantly younger and more likely to be female and had fewer IPS consultations than those who discontinued buprenorphine. Buprenorphine was restarted postoperatively for 143 (52%) patients and held for 132 (48%) postoperatively. Conclusions The use of buprenorphine perioperatively was associated with significantly reduced oral morphine equivalent (OME) requirements postoperatively. Further research is needed to give definitive recommendations for whether to continue or discontinue buprenorphine prior to surgery.