Perioperative outcomes for patients on chronic buprenorphine undergoing spine surgery: A case series

Ashley L. Sharp, MD; Stephanie Gilbert, MD; Danielle N. Perez, MD; Kerstin Kolodzie, MD, PhD, MAS; Matthias Behrends, MD

doi:10.5055/jom.2021.0655

Authors

Ashley L. Sharp, MD https://orcid.org/0000-0002-9585-2104
Stephanie Gilbert, MD
Danielle N. Perez, MD
Kerstin Kolodzie, MD, PhD, MAS
Matthias Behrends, MD

DOI:

https://doi.org/10.5055/jom.2021.0655

Keywords:

buprenorphine, opioid use disorder, anesthesia, acute pain

Abstract

Objective: Pain management following spine surgery can be challenging as patients routinely suffer from chronic pain and opioid tolerance. The increasing popularity of buprenorphine use for pain management in this population may further complicate perioperative pain management due to the limited efficacy of other opioids in the presence of buprenorphine. This study describes perioperative management and outcomes in patients on chronic buprenorphine who underwent elective inpatient spine surgery.

Design: The authors performed a retrospective chart review of all patients >18 years of age taking chronic buprenorphine for any indication who had elective inpatient spine surgery at a single institution. Perioperative pain management data were analyzed for all patients who underwent spine surgery and were maintained on buprenorphine during their hospital stay.

Setting: The study was performed at a single tertiary academic medical center.

Main outcome measures: The primary outcome measures were post-operative pain scores and analgesic medication requirements.

Results: Twelve patients on buprenorphine underwent inpatient spine surgery. Acceptable pain control was achieved in all cases. Management included preoperative dose limitation of buprenorphine when indicated and the extensive use of multimodal analgesia.

Conclusion: The question whether patients presenting for painful, elective surgery should continue using buprenorphine perioperatively is an area of controversy, and the present manuscript provides more evidence for the concept of therapy continuation with buprenorphine.

Author Biographies

Ashley L. Sharp, MD

Department of Anesthesia and Perioperative Care, University of California, San Francisco, California

Stephanie Gilbert, MD

Department of Anesthesia and Perioperative Care, University of California, San Francisco, California

Danielle N. Perez, MD

Department of Pediatrics, University of California, San Francisco, California

Kerstin Kolodzie, MD, PhD, MAS

Department of Anesthesia and Perioperative Care, University of California, San Francisco; Department of Epidemiology and Biostatistics, University of California, San Francisco, California

Matthias Behrends, MD

Department of Anesthesia and Perioperative Care, University of California, San Francisco, California

References

Heit HA, Gourlay DL: Buprenorphine. Clin J Pain. 2008; 24: 1-5.

Anderson TA, Quaye AN, Ward N, et al.: To stop or not, that is the question: Acute pain management for the patient on chronic buprenorphine. Anesthesiology. 2017; 126: 1180-1186.

Boas RA, Villiger JW: Clinical actions of fentanyl and buprenorphine: The significance of receptor binding. Br J Anaesth. 1985; 57(2): 192-196.

Kornfield H, Manfredi L: Effectiveness of full agonist opioids in patients stabilized on buprenorphine undergoing major surgery: A case series. Am J Ther. 2010; 17: 523-528.

Quaye AN, Zhang Y: Perioperative management of buprenorphine: Solving the conundrum. Pain Med. 2018; 54(10): 901-914.

Center for Substance Abuse Treatment: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40. DHHS Publication No. (SMA) 04-3939. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2004.

Lembke A, Ottestad E, Schmiesing C: Patients maintained on buprenorphine for opioid use disorder should continue buprenorphine through the perioperative period. Pain Med. 2019; 20(3): 425-428.

CMS: Opioid Oral Morphine Milligram Equivalent (MME) Conversion Factors, 2018. Baltimore, MD. Available at https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Oral-MME-CFsvFeb-2018.pdf. Accessed February 3, 2019.

Martin YA, Pearson AC, Tranchida JR, et al.: Implications of uninterrupted preoperative transdermal buprenorphine use on post-operative pain management. Reg Anesth Pain Med. 2019; 44: 342-47.