Perioperative pain management and outcomes in patients who discontinued or continued pre-existing buprenorphine therapy

Authors

DOI:

https://doi.org/10.5055/jom.2021.0640

Keywords:

buprenorphine, pain, surgery

Abstract

Objective: This study compared opioid utilization and clinical outcomes in surgical patients receiving maintenance buprenorphine therapy who discontinued versus those who continued buprenorphine treatment perioperatively. Lack of high-quality evidence, conflicting results in previous studies, and the possible need for reinduction after discontinuing therapy present clinicians with the complicated dilemma of choosing the best strategy to control post-operative pain in patients receiving buprenorphine.

Design: A multicenter, retrospective cohort study.

Participants: Hospitalized patients between January 1, 2017 and December 12, 2019 who underwent any type of surgery, had a documentation of an outpatient buprenorphine prescription or inpatient order, and received buprenorphine for 5 or more days prior to the procedure were included.

Main outcome measure(s): The primary objective was to compare mean 24-hour morphine milligram equivalent (MME) utilization post-operatively between patients who discontinued buprenorphine preoperatively versus those who continued therapy throughout the perioperative period.

Results: Fifty-one patients met the inclusion criteria for this study. Of these, 42 patients were continued on buprenorphine through surgery, while nine patients had a documentation of discontinuation preoperatively. The 24-hour post-operative MME utilization (interquartile range) was 58.8 (18-100.8) in patients who continued therapy through surgery versus 152.6 (114.5-236) in patients who discontinued therapy preoperatively (p = 0.005). There were no significant differences in post-operative pain scores or length of stay between groups.

Conclusion: Post-operative opioid use was significantly lower in patients who continued buprenorphine compared with those who discontinued buprenorphine preoperatively.

 

Author Biographies

Aamer Attaar, PharmD, BCPS

Dell Seton Medical Center at The University of Texas, Austin, Texas

Molly Curran, PharmD, BCPS, BCCCP

Ascension Seton Medical Center Austin, Austin, Texas

Lyndsi Meyenburg, PharmD, BCPS

Ascension Seton Northwest, Austin, Texas

Richard Bottner, DHA, PA-C

Dell Medical School at The University of Texas at Austin, Austin, Texas

Clarissa Johnston, MD

Dell Medical School at The University of Texas at Austin, Austin, Texas

Kirsten Roberts Mason, PharmD, BCPS

Ascension Seton Medical Center Austin, Austin, Texas

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Published

08/01/2021

How to Cite

Attaar, PharmD, BCPS, A., M. Curran, PharmD, BCPS, BCCCP, L. Meyenburg, PharmD, BCPS, R. Bottner, DHA, PA-C, C. Johnston, MD, and K. R. Mason, PharmD, BCPS. “Perioperative Pain Management and Outcomes in Patients Who Discontinued or Continued Pre-Existing Buprenorphine Therapy”. Journal of Opioid Management, vol. 17, no. 7, Aug. 2021, pp. 33-41, doi:10.5055/jom.2021.0640.