Abstract

OBJECTIVES: Given there are conflicting recommendations for the perioperative management of buprenorphine, we conducted a retrospective cohort study of our surgery patients on buprenorphine whose baseline dose had been preoperatively continued, tapered or discontinued.METHODS: With IRB approval, we reviewed charts from January 1, 2013 to June 30, 2016 of patients on buprenorphine who had received elective surgery at Stanford Healthcare. Our primary outcome of interest was the change in pain score, defined as mean postoperative pain score - preoperative pain score. We also collected data on patients' tapering procedure and any postoperative non-buprenorphine opioid requirements.RESULTS: Out of approximately 1200 patients on buprenorphine, 121 had surgery of which 50 were admitted and included in the study. Perioperative continuation of transdermal buprenorphine resulted in a lower change in pain score postoperatively (0.606±0.878) than discontinuation (4.83±1.23, P=0.012). Among sublingual patients, there was no difference in the change in pain score between those who were tapered to a non-zero dose versus discontinued (P=0.55). Continuation of sublingual buprenorphine resulted in fewer non-buprenorphine scheduled opioid prescriptions than its taper or discontinuation (P=0.028). Finally, tapers were performed with great variability in the tapering team and rate of taper.DISCUSSION: Based on our findings, we implemented a policy at our institution for the continuation of perioperative buprenorphine whenever possible. Our work reveals crucial targets for the education of perioperative healthcare providers and the importance of coordination amongst all perioperative services and providers.

View details for DOI 10.1097/AJP.0000000000000858

View details for PubMedID 32520814