Articles  |   November 2018
SEE Question
Article Information
Pain Medicine / Articles / Opioid
Articles   |   November 2018
SEE Question
ASA Monitor 11 2018, Vol.82, 52-55.
ASA Monitor 11 2018, Vol.82, 52-55.
A 48-year-old man with a history of severe depression, former heroin use and chronic low back pain presents for elective minor scar revision surgery. He is taking 8 mg of buprenorphine sublingually daily, and a recent urine screen was negative for illicit substances. Which of the following is the best course of action for his buprenorphine use perioperatively?
Buprenorphine has emerged as a new therapy for chronic pain, addiction and opioid use disorder. It may be marketed as Suboxone®, Zubsolv® or Bunavail®, which are a combination of buprenorphine and naloxone. Buprenorphine has several unique properties that potentially make it safer than other types of opioids. It is 30 times more potent than morphine, has a long and variable half-life and has a ceiling effect for respiratory depression. There is evidence to show that buprenorphine can decrease chronic pain, opioid-induced hyperalgesia, depression, opioid cravings and relapse. Buprenorphine competes with other opioids for the opioid receptor, which may make the use of perioperative supplemental opioids problematic in a patient with long-term buprenorphine use.
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