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Emerging Trends in Perioperative Buprenorphine Management
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The following questions and topics will be covered in this presentation.
1: Which of the following represents a concern associated with inpatient discontinuation of buprenorphine?
a) Improved anxiety level
b) Reduced staffing requirements
c) Suboptimal analgesia
d) Decreased relapse risk
2: AB is a 43-year-old man who is being rushed to the ED with substantial traumatic injury post MVA. When he reaches the hospital, an ER nurse finds a medical bracelet that shows that he takes buprenorphine/naloxone 8/2 mg. A medication reconciliation is conducted and after contacting his community pharmacy and reviewing PDMP-iSTOP, it is confirmed that the patient takes buprenorphine/naloxone 8/2 mg SL BID. Which of the following is a reasonable approach to managing buprenorphine while the patient undergoes acute treatment for his MVA and associated painful injuries?
a) The patient should not receive buprenorphine/naloxone while on opioid agonists.
b) The patient should receive half his usual buprenorphine/naloxone dose while in the hospital.
c) The patient should continue to receive his buprenorphine/naloxone at the same dose he was receiving prior to admission.
d) The patient should receive twice his usual dose of buprenorphine/naloxone in addition to other opioid analgesia for acute pain relief
3: Which of the following statements regarding buprenorphine is TRUE?
a) If a patient is on an opioid agonist and initiates buprenorphine/naloxone, the naloxone will cause the patient to go into precipitated opioid withdrawal.
b) When admitted for a surgical procedure, the patient must have their buprenorphine discontinued prior to the procedure.
c) The inpatient team should not be concerned with coordination of a follow up appointment with the primary buprenorphine prescriber at discharge.
d) Buprenorphine/naloxone can be effectively used for pain management or opioid use disorder.
4: Which of the following medications could be used to improve pain control for a patient that is being managed post operatively for pain control while also on buprenorphine 12mg daily?
a) Pregabalin
b) Ketamine
c) Metoprolol
d) A and B
e) None of the above the buprenorphine will provide enough analgesia post operatively
5: Which of the following statements is TRUE regarding published perioperative buprenorphine management protocols?
a) All buprenorphine products should be stopped prior to procedure and full opioid agonists should be used to control pain
b) Buprenorphine continuation can only take place if the hospital has the proper license as not all hospitals can use buprenorphine for addiction
c) Buprenorphine continuation is patient specific and warrants collaboration with buprenorphine prescriber as well as the anesthesia team
d) No consensus on how to manage these patients has been found