Background: Buprenorphine, a partial opioid agonist, displaces full opioid agonists from receptors and may\nimpede surgical pain management. We report the effects of a sublingual formulation of buprenorphine-naloxone,\nSuboxone (SL-BUP), on perioperative pain management.\nMethods: We identified all adult surgical patients from December 31, 2004, to January 1, 2016, who received SLBUP\nwithin 30 days prior to procedures performed with general, regional, or combined general/regional anesthesia.\nWe recorded opioid use during the procedure, in the post-anesthesia care unit (PACU), and during the 24 h\nfollowing PACU discharge. We also examined opioid use in those who continued SL-BUP until the day of surgery vs\nthose who preoperatively discontinued SL-BUP.\nResults: Thirty-two patients were treated preoperatively with SL-BUP. Three patients had regional anesthesia only,\nand opioid requirements were case dependent. Requirements were minimal for creation of an arteriovenous fistula\nand high following knee replacement and cesarean section. Twelve patients received combined general/regional\nanesthesia, and 17 received general anesthesia only. Intraoperative and PACU opioid use in these 2 groups were\nnot significantly different (P = .10 and P = .93, respectively). In both groups opioid use increased after discharge from\nthe PACU, and remained comparable between the general and combined general/regional group through the first\n24 h after PACU discharge (P = .78). Although median [interquartile range] 24-h opioid doses were higher among\npatients who discontinued SL-BUP, the difference was not statistically significant in the general anesthesia-only\ngroup (SL-BUP discontinued, 199 [110-411] mg IV-MEq [intravenous morphine equivalent] vs SL-BUP continued, 106\n[58-160] mg IV-MEq; P = .15) or in the combined general/regional group (SL-BUP discontinued, 140 [100-157] mg\nIV-MEq vs SL-BUP continued, 100 [73-203] mg IV-MEq; P = .94).\nConclusions: Regardless of the type of anesthesia used, physicians treating patients with SL-BUP must be prepared\nto administer large doses of opioids during the early postoperative period. No difference in opioid requirements\nwas noted between patients who perioperatively stopped SL-BUP versus those who continued SL-BUP.
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