Abstract
Derived from thebaine, an alkaloid found in the Papaver somniferum plant, buprenorphine is a semisynthetic, centrally acting, partial agonist for the opioid receptor. It is used clinically as an analgesic and more recently as opioid replacement therapy for the treatment of opioid dependence. Although methadone has historically been the agent of choice for the pharmacologic treatment of opioid abuse, buprenorphine has a more favorable safety profile and lower abuse potential. In low doses buprenorphine is a long-acting and easily administered analgesic for moderate pain. Potentially a treatment for opioid-induced hyperalgesia, buprenorphine offers promise for the treatment of chronic pain and opioid dependence. The prevalence of patients taking buprenorphine who present for surgical procedures is increasing as the prevalence of buprenorphine therapy rises. The same pharmacologic characteristics that make buprenorphine a safe and effective treatment option complicate perioperative pain management. Effective perioperative analgesia is possible in patients taking buprenorphine but requires expertise and awareness of the drug’s properties.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Bryson EO. The perioperative management of patients maintained on medications used to manage opioid addiction. Curr Opin Anaesthesiol. 2014;27:359–64.
Bryson E, Lipson S, Gevirtz C. Anesthesia for patients on buprenorphine. Anesthesiol Clin. 2010;28:611–7.
Chen KY, Chen L, Mao J. Buprenorphine-naloxone therapy in pain management. Anesthesiology. 2014;120:1262–74.
Gevirtz C, Frost EAM, Bryson EO. Perioperative implications of buprenorphine maintenance treatment for opioid addiction. Int Anesthesiol Clin. 2011;49:147–55.
Roberts MD, Meyer-Witting M. High-dose buprenorphine: perioperative precautions and management strategies. Anaesth Intensive Care. 2005;33:17–25.
Vadivelu N, Mitra S, Kaye AD, Urman RD. Perioperative analgesia and challenges in the drug-addicted and drug-dependent patient. Best Pract Res Clin Anaesthesiol. 2014;28:91–101.
Huang A, Katznelson R, de Perrot M, Clarke H. Perioperative management of a patient undergoing Clagett window closure stabilized on Suboxone for chronic pain: a case report. Can J Anaesth. 2014;61:826–31.
Cruciani RA, Knotkova H, editors. Handbook of methadone prescribing and buprenorphine therapy. New York: Springer; 2013.
Ingelheim B. Buprenorphine sublingual tablets prescribing information. Columbus: Roxane Laboratories; 2015.
McCormick Z, Chu S, Chang-Chien G, Joseph P. Acute pain control challenges with buprenorphine/naloxone therapy in a patient with compartment syndrome secondary to McArdle’s disease: a case report and review. Pain Med. 2013;14:1187–91.
Suboxone.com [Internet]. Richmond, VA: Indivior Inc; 2015. Available from http://www.suboxone.com. Accessed 5 Oct 2015.
Substance abuse and mental health services administration [Internet]. Rockville, MD: SAMHSA. Available from http://www.samhsa.gov. Accessed 7 Oct 2015.
Huxtable CA, Roberts LJ, Somogyi AA, Macintyre PE. Acute pain management in opioid-tolerant patients: a growing challenge. Anaesth Intensive Care. 2011;39:804–23.
Childers JW, Arnold RM. Treatment of pain in patients taking buprenorphine for opioid addiction #221. J Palliat Med. 2012;15(5):613–4.
Kornfeld H, Manfredi L. Effectiveness of full agonist opioids in patients stabilized on buprenorphine undergoing major surgery: a case series. Am J Ther. 2010;17:523–8.
Jones HE, Johnson RE, Milio L. Post-cesarean pain management of patients maintained on methadone or buprenorphine. Am J Addict. 2006;15:258–9.
Harrington C, Zaydfudim V. Buprenorphine maintenance therapy hinders acute pain management in trauma. Am Surg. 2010;76:397–9.
Book SW, Myrick H, Malcolm R, Strain EC. Buprenorphine for postoperative pain following general surgery in a buprenorphine-maintained patient. Am J Psychiatry. 2007;164:979.
Alford DP, Compton P, Samet JH. Acute pain management for patients receiving maintenance methadone or buprenorphine therapy. Ann Intern Med. 2006;144:127–34.
Chern SYS, Isserman R, Chen L, Ashburn M, Liu R. Perioperative pain management for patients on chronic buprenorphine: a case report. J Anesth Clin Res. 2012;3:1–4.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Kozarek, K., Dickerson, D.M. (2018). Buprenorphine Challenges in the Perioperative Period. In: Anitescu, M., Benzon, H., Wallace, M. (eds) Challenging Cases and Complication Management in Pain Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-60072-7_49
Download citation
DOI: https://doi.org/10.1007/978-3-319-60072-7_49
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-60070-3
Online ISBN: 978-3-319-60072-7
eBook Packages: MedicineMedicine (R0)