Category: Federal Forum Posters
Purpose: Buprenorphine is a mu-opioid receptor partial agonist and kappa receptor antagonist approved for the treatment of opioid use disorder (alone or in combination with naloxone), acute pain (parenterally), or chronic pain (buccal film or transdermal patch). Buprenorphine’s unique pharmacologic and pharmacokinetic characteristics make treating acute pain in patients on long-term therapy challenging. Perioperatively, as an elective or emergency procedure, clinicians lack a standardized protocol for management of the expected postsurgical pain. The purpose of this project is to analyze available literature and develop a protocol for perioperative pain management of patients on chronic buprenorphine therapy for elective versus emergency surgeries.
Methods: In consideration of developing an open access perioperative protocol for how to treat patients receiving buprenorphine when faced with elective versus emergent surgery, we queried PubMed, Ovid, and Cochrane Library for published articles related to procedures or studies of buprenorphine use perioperatively for any type of surgical procedure. The search was limited to studies within the past 5 years, in human subjects, written in English, and studied in adults at least 19 years of age. Search terms included “buprenorphine”, “acute pain”, “acute pain management”, “perioperative pain”, “elective and emergency procedures”, “opioid maintenance”, and “opioid addiction”. Another search was performed to include community resources such as paindr.com and professional organization websites (American Pain Society and American Society of Addiction Medicine) to obtain a more comprehensive list of articles related to this topic.
Results: Extensive literature search was performed with the limitations stated in the methods section for the databases and the articles listed in the community resources and organization websites reviewed. Results of the search showed that as of September 26, 2018, there are no controlled prospective human trials outlining such protocol. Currently, there are two case studies, five case series, three retrospective cohorts, two in-vitro studies, two safety studies, six pharmacokinetic studies, one observational study, and thirty-one review articles that have been published and will be utilized to create the proposed protocol. Final Protocol is still pending at this time.
Jeffrey Bettinger– PGY1 Pharmacy Resident, Albany Stratton VA Medical Center, Delmar, NY