Comparison of PACU length of stay and opioid requirements of patients maintained on buprenorphine or methadone for opioid use disorder

Rebecca C. Dale, DO; Carol L. Metcalf, ARNP; Christina Bockman, PharmD; Dale J. Langford, PhD; Christine T. Fong, MS; Katherin A. Peperzak, MD

doi:10.5055/jom.2022.0689

Authors

Rebecca C. Dale, DO https://orcid.org/0000-0003-4378-002X
Carol L. Metcalf, ARNP
Christina Bockman, PharmD
Dale J. Langford, PhD
Christine T. Fong, MS
Katherin A. Peperzak, MD

DOI:

https://doi.org/10.5055/jom.2022.0689

Keywords:

buprenorphine, methadone, opioid use disorder

Abstract

Objectives: Literature supporting best practice of perioperative buprenorphine management for opioid use disorder is evolving with more recent studies trending toward maintenance of home dose. To guide treatment protocols at our institution, we evaluated patients taking medication for opioid use disorder (MOUD) undergoing similar surgeries. Patients were maintained on either their outpatient buprenorphine or methadone.

Patients and participants: Data were collected on 46 patients maintained on buprenorphine MOUD who underwent surgery. A subset of these patients (n = 24) was compared with 24 patients maintained on methadone MOUD, matched on surgical procedure, admission date, age, and sex.

Design: This is a retrospective matched control study.

Setting: An academic, tertiary, Level 1 trauma center.

Main outcome measures: Primary outcomes were post-operative opioid use and post-anesthesia care unit (PACU) length of stay.

Results: No significant differences in demographic characteristics, physical status, comorbid psychiatric diagnoses, or illicit substance use history were observed between patient groups. A higher proportion of patients taking methadone was admitted due to infection (41.7 percent vs 16.7 percent, p = 0.031) and underwent nonelective surgery (75.0 percent vs 45.8 percent, p = 0.039). No significant differences were observed between patients taking buprenorphine versus methadone with respect to PACU length of stay, post-operative opioid consumption, time-to-transition to oral opioids, or discharge opioid prescriptions. Patients taking buprenorphine were more likely to receive intravenous lidocaine (25.0 percent vs 0.0 percent, p = 0.031) and ketamine (83.3 percent vs 54.2 percent, p = 0.039).

Conclusion: Findings from this study support accumulating evidence that patients should be maintained on buprenorphine MOUD throughout the perioperative period.

Author Biographies

Rebecca C. Dale, DO

Assistant Professor, Harborview Medical Center, Seattle, Washington

Carol L. Metcalf, ARNP

Clinical Nurse Practitioner, Harborview Medical Center, Seattle, Washington

Christina Bockman, PharmD

Clinical Pharmacist, Harborview Medical Center, Seattle, Washington

Dale J. Langford, PhD

Researcher, University of Washington, Seattle, Washington

Christine T. Fong, MS

Computer Specialist, University of Washington, Seattle, Washington

Katherin A. Peperzak, MD

Assistant Professor, Harborview Medical Center, Seattle, Washington

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