Perioperative opioid requirements of patients receiving sublingual buprenorphine-naloxone: a case series

Abstract

BackgroundBuprenorphine, a partial opioid agonist, displaces full opioid agonists from receptors and may impede surgical pain management. We report the effects of a sublingual formulation of buprenorphine-naloxone, Suboxone (SL-BUP), on perioperative pain management.MethodsWe identified all adult surgical patients from December 31, 2004, to January 1, 2016, who received SL-BUP within 30 days prior to procedures performed with general, regional, or combined general/regional anesthesia. We recorded opioid use during the procedure, in the post-anesthesia care unit (PACU), and during the 24 h following PACU discharge. We also examined opioid use in those who continued SL-BUP until the day of surgery vs those who preoperatively discontinued SL-BUP.ResultsThirty-two patients were treated preoperatively with SL-BUP. Three patients had regional anesthesia only, and opioid requirements were case dependent. Requirements were minimal for creation of an arteriovenous fistula and high following knee replacement and cesarean section. Twelve patients received combined general/regional anesthesia, and 17 received general anesthesia only. Intraoperative and PACU opioid use in these 2 groups were not significantly different (P = .10 and P = .93, respectively). In both groups opioid use increased after discharge from the PACU, and remained comparable between the general and combined general/regional group through the first 24 h after PACU discharge (P = .78). Although median [interquartile range] 24-h opioid doses were higher among patients who discontinued SL-BUP, the difference was not statistically significant in the general anesthesia–only group (SL-BUP discontinued, 199 [110–411] mg IV-MEq [intravenous morphine equivalent] vs SL-BUP continued, 106 [58–160] mg IV-MEq; P = .15) or in the combined general/regional group (SL-BUP discontinued, 140 [100–157] mg IV-MEq vs SL-BUP continued, 100 [73–203] mg IV-MEq; P = .94).ConclusionsRegardless of the type of anesthesia used, physicians treating patients with SL-BUP must be prepared to administer large doses of opioids during the early postoperative period. No difference in opioid requirements was noted between patients who perioperatively stopped SL-BUP versus those who continued SL-BUP.