Buprenorphine: An anesthesia-centric review

Thomas Hickey; Gregory Acampora

doi:10.5055/jom.0901

Authors

Thomas Hickey, MD, MS https://orcid.org/0000-0003-4890-0238
Gregory Acampora, MD

DOI:

https://doi.org/10.5055/jom.0901

Keywords:

buprenorphine, perioperative, Suboxone®, acute pain, chronic pain, opioid adverse effects

Abstract

Buprenorphine was synthesized in the 1960s as a result of a search for a safe and effective opioid analgesic. Present formulations of buprenorphine are approved for the treatment of both acute and chronic pain. Its long duration of action, high affinity, and partial agonism at the μ-opioid receptor have established it as a mainstay treatment for opioid use disorder (OUD). Full agonist opioids (FAOs) remain a primary choice for perioperative pain in both opioid-naïve and opioid-tolerant patients despite well-known harms and new emphasis on multimodal analgesia strategies prioritizing nonopioid analgesics. We review the evidence supporting the use of buprenorphine as an effective analgesic alternative to more commonly prescribed FAOs in acute and chronic pain management. For the patient prescribed buprenorphine for OUD, prior conventionalism advised temporary discontinuation of buprenorphine preoperatively; this paradigm has shifted toward continuing buprenorphine throughout the perioperative period. Questions remain whether dose adjustments may improve patient outcomes.

Author Biographies

Thomas Hickey, MD, MS

Assistant Professor, Anesthesiology, Yale University School of Medicine; VA Connecticut Healthcare System, New Haven, Connecticut

Gregory Acampora, MD

Psychiatrist; Assistant Professor, Harvard Medical School; MGH/Harvard Center for Addiction Medicine, Massachusetts General Hospital; Addiction Leadership, Charlestown Community Health Care Center for Pain Management; HOME BASE Veterans and Family Care, Boston, Massachusetts

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