Buprenorphine has been widely used in opioid maintenance therapy in the last decade. However, buprenorphine has a multi-mechanistic pharmacological profile and its unique analgesic efficacy in acute and chronic pain management may not be fully known to many anesthesia providers. Recent studies have supported the use of buprenorphine as an effective analgesic in adult and pediatric population. Several clinical studies and trials have suggested the use of buprenorphine as an attractive opioid for patients in the perioperative setting. In this presentation, buprenorphine’s receptor pharmacology and pharmacokinetics will be reviewed. Specifically, misinterpretation of its intrinsic mu activity, ceiling effect and analgesic efficacy will be clarified. Pain management options and guidelines for the surgical patients on buprenorphine will be discussed as well. At the end of the presentation, learners will be able to verbalize buprenorphine’s receptor pharmacology, pharmacokinetics and analgesic efficacy compared to other opioids. In addition, learners will familiarize the current recommendations on surgical patients who are on buprenorphine.