Journal article
Implications of uninterrupted preoperative transdermal buprenorphine use on postoperative pain management
Regional anesthesia and pain medicine, Vol.44(3), pp.342-347
03/2019
DOI: 10.1136/rapm-2018-100018
PMID: 30635504
Abstract
Background and objectivesBuprenorphine is a partial µ-receptor agonist resistant to displacement from receptors by conventional opioids, which can block the effect of conventional opioids and may interfere with postoperative pain management. We aimed to quantify perioperative opioid use in patients receiving transdermal buprenorphine (TdBUP).MethodsWe identified patients receiving TdBUP who underwent surgery between 2004 and 2016. To compare opioid requirements (intravenous morphine equivalents (IV-MEq)), we constructed a matched study, matching each TdBUP patient with two opioid-naive patients by sex, age, and type of anesthesia and procedure.ResultsNineteen unique patients underwent 22 procedures while receiving TdBUP. Total (IQR) amounts of IV-MEq (intraoperative, recovery room, and 24 hours after recovery-room discharge) were 98 (63, 145) and 46 (30, 65) mg IV-MEq for TdBUP and opioid-naive patients, respectively (p<0.001). Postoperative IV-MEq requirements were 54 (38, 90) and 15 (3, 35) mg for TdBUP and opioid-naive patients, respectively (p<0.001). Among TdBUP patients, higher preoperative doses of TdBUP were associated with greater postoperative opioid requirements (p=0.02). Specifically, patients with a 20 µg/hour TdBUP patch required 133.8 mg IV-MEq more postoperatively than patients with a 5 µg/hour patch (p=0.002). Following discharge from the recovery room, 17 (77%) TdBUP patients and 15 (34%) opioid-naive patients reported severe pain (OR 6.6 (95% CI 2.0 to 21.3); p<0.001; adjusting for baseline pain score, 5.0 (95% CI, 1.4 to 17.8); p=0.01).ConclusionsAnalgesic management for patients receiving TdBUP therapy must account for increased opioid needs, and greater preoperative doses of TdBUP were associated with greater postoperative opioid requirements.
Details
- Title: Subtitle
- Implications of uninterrupted preoperative transdermal buprenorphine use on postoperative pain management
- Creators
- Yvette N Martin - Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USAAmy C S Pearson - Department of Anesthesia, University of Iowa Health Care, Iowa City, Iowa, USAJohn R Tranchida - Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USAToby N Weingarten - Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USAPhillip J Schulte - Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USAJuraj Sprung - Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Resource Type
- Journal article
- Publication Details
- Regional anesthesia and pain medicine, Vol.44(3), pp.342-347
- DOI
- 10.1136/rapm-2018-100018
- PMID
- 30635504
- ISSN
- 1098-7339
- eISSN
- 1532-8651
- Language
- English
- Date published
- 03/2019
- Academic Unit
- Anesthesia
- Record Identifier
- 9984007160702771
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