Management of Patients With Opioid Use Disorder (OUD)

Managing patients with opioid use disorder (OUD) presents a critical challenge in the perioperative setting. Due to challenges like opioid-induced hyperalgesia (OIH), withdrawal and relapse risks, and altered opioid pharmacodynamics, traditional pain management strategies may be inadequate or even counterproductive. Despite the inconsistency in clinical guidelines and variation in perioperative protocols for OUD patients, mounting evidence indicates that effective analgesia techniques do exist, such as multimodal analgesia, regional anesthesia, opioid agonist therapy (OAT), and non-opioid adjuncts. Evidence suggests that continuing OAT (methadone or buprenorphine) during the perioperative period may improve pain control and reduce relapse risk. Multimodal analgesia techniques decrease opioid usage while increasing pain relief. This review will highlight literature that demonstrates the effectiveness and benefit of these treatments for OUD patients. The complexity of OUD and its impact on perioperative care requires a patient-centered, multidisciplinary approach in order to increase safety and optimize patient outcomes. This review demonstrates the need to address research gaps, reduce the negative stigma surrounding this disorder, and establish standardized clinical guidelines that prioritize multimodal pain management and inclusive OUD treatment strategies.