An Individualized, Interdisciplinary Approach to the Perioperative Care of Patients on Buprenorphine

This review provides an overview of the pharmacodynamics and pharmacokinetics of buprenorphine followed by a review of the published research on the perioperative use of buprenorphine for acute postoperative pain, and analgesia management in patients already on buprenorphine.

Current evidence comparing buprenorphine with full opioid agonists is heterogeneous, showing either modest superiority or comparable analgesic efficacy, with a reduced incidence of certain adverse effects such as respiratory depression. Despite concerns that its high receptor affinity may limit the efficacy of additional opioids, buprenorphine can be safely combined with other opioid agonists for breakthrough and perioperative pain. Perioperative management requires an individualized, interdisciplinary approach, taking into account patient-specific risk factors. Multimodal analgesia-including regional techniques, non-opioid medications, adjunctive agents, and nonpharmacological strategies-forms the cornerstone of effective perioperative pain control. A structured postoperative plan with dose adjustment, coordinated follow-up, and collaboration with outpatient prescribers is critical. Early involvement of the Acute Pain Services team could be beneficial.