Establishing Buprenorphine for Acute Postoperative Pain Management

Opioids continue to be relied on to treat postoperative pain and continue to result in harms ranging from pruritis to overdose. The partial agonist opioid buprenorphine was synthesized in the 1960s as result of a search for a safe and effective opioid analgesic. While formulations of buprenorphine are approved for the treatment of pain, it is more commonly known as a medication for opioid use disorder. However, there is increasing interest in employing buprenorphine as a front-line perioperative opioid analgesic. We review the continued reliance on full agonist opioids and associated harms, highlight key efficacy and safety advantages of buprenorphine compared to usual care opioids, and describe the evolution of our consideration of buprenorphine for acute perioperative pain management. We then describe the process by which we worked within our institution to arrive at a twice daily buccal film and describe the clinical pathway ultimately implemented, providing details on training of staff, order set development, and surgical populations included. Buprenorphine presents a promising opportunity to reduce opioid harms while potentially improving pain outcomes after surgery. Our experience suggests that the buccal formulation possesses unique advantages for perioperative administration. Future directions will inform buprenorphine's impact on key pain and opioid-related outcomes.