Buprenorphine Formulations: Clinical Best Practice Strategies Recommendations for Perioperative Management of Patients Undergoing Surgical or Interventional Pain Procedures

摘要

Background: Starting with approval for clinical use in the treatment of opioid dependence inOctober 2002 by the Food and Drug Administration (FDA), buprenorphine has become an integraltreatment option and in recent years, in chronic pain management. Buprenorphine possesses aunique pharmacodynamic and pharmacokinetic profile that can potentially make perioperativeanalgesia challenging.Objectives: To date no unified guidelines or recommendations are available for buprenorphineproduct management during the perioperative period. The present investigation aims to review theliterature and provide recommendations when encountering a patient on buprenorphine therapywho is scheduled for a surgical or interventional pain procedure.Methods: Clinical studies and reviews were searched using the PubMed National Center forBiotechnology Information database using MeSH terms buprenorphine, buprenorphine andnaloxone, suboxone, perioperative, and postoperative pain.Results: PubMed National Center for Biotechnology Information database search resulted in onerandomized control trial, one prospective case matched cohort, one retrospective cohort, 0 caseseries, 4 case reports, and 6 review articles. Key literature is reviewed and summarized.Limitations: Only 12 articles were included, which permits only limited recommendations drawnfrom this review.Conclusions: The perioperative management of buprenorphine and buprenorphinealoxoneare dependent on several key factors. The nature of the surgery, namely the postoperativeopioid requirement, elective versus emergency surgery, patient characteristics, formulation ofbuprenorphine, and indication for buprenorphine or buprenorphinealoxone therapy must beconsidered when devising a plan. Several options exist when formulating a plan for the perioperativemanagement, including continuing buprenorphine therapy or holding buprenorphine therapy for adefined period of time with or without bridging to alternative opioids. Additionally, social supportpeople and patient motivation should be addressed and optimized, as well as nonopioid adjuvanttherapy should be maximized as applicable to each patient undergoing a surgical or interventionalpain procedure.