Abstract

Currently, there is no consensus on continuing vs. holding buprenorphine preoperatively. Management of post-operative pain in patients on buprenorphine has been hotly debated, with evidence showing for and against stopping buprenorphine prior to surgery. This case series will examine 6 VA patients who have underwent a variety of surgeries with different levels of expected pain. Patients who undergo minor surgeries with low expected pain can safely continue buprenorphine. None of our patients who underwent minor surgeries and continued buprenorphine reported significant pain, even for a patient 5 who underwent cholecystectomy. Patient 2 endorsed additional pain relief when he increased his buprenorphine from 16 to 32 mg daily to help with his post-operative pain.

Patients who underwent major surgeries such as hip replacements and wrist joint arthroplasty held their buprenorphine and transitioned to full mu opioid prescription before restarting buprenorphine. Only one patient had a positive post-operative urine drug screen for opioids. Patients show resiliency against opioid use even when undergoing surgeries involving stopping their buprenorphine. Many approaches exist to manage pain perioperatively in patients prescribed buprenorphine. Regardless of which approach, patients should be monitored perioperatively for craving and withdrawal from opioids.