(963) Perioperative Management of Buprenorphine at an Urban Academic Medical Center

Introduction: Buprenorphine is a partial mu-opioid receptor agonist with high affinity to its receptor, which raises concerns of blocking or displacing full opioid agonists when used during the perioperative period of surgical patients. However, buprenorphine itself has high analgesic potency. Discontinuing buprenorphine may lead to suboptimal pain control and increase the risk for opioid use disorder (OUD) relapse. There is limited data for the continuation of buprenorphine perioperatively.

Methods: This study is a retrospective cohort study of adult surgical patients taking buprenorphine for OUD at an urban, teaching, level 1 trauma center. Patients were split into two groups based on whether buprenorphine was continued or held within the first 48 hours after surgery.

Results: Those who had buprenorphine continued in the first 48 hours postoperatively required half the dose of non-buprenorphine opioids compared to those who had buprenorphine held (196.4 versus 403.4 oral morphine equivalents, p = 0.0150). Both groups had a similar level of analgesia and incidence of adverse events. Nearly all patients who continued buprenorphine in the first 48 hours postoperatively were discharged on this agent, while only half of patients who had buprenorphine held were restarted on it at discharge (92.68% versus 56.52%, p = 0.0013).

Conclusions: This present study found lower non-buprenorphine opioid requirements in patients with continued versus held perioperative buprenorphine use with no difference in analgesia.