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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 2/2019

01-02-2019 | Review Article/Brief Review

The perioperative patient on buprenorphine: a systematic review of perioperative management strategies and patient outcomes

Authors: Akash Goel, MD, Saam Azargive, MSc, Wiplove Lamba, MD, Joel Bordman, MD, DAAPM, Marina Englesakis, BA, MLIS, Sanjho Srikandarajah, MD, Karim Ladha, MD, MSc, Tania Di Renna, MD, Harsha Shanthanna, MD, MSc, Scott Duggan, MD, MSc, Philip Peng, MBBS, John Hanlon, MD, MSc, Hance Clarke, MD, PhD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 2/2019

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Abstract

Background

An increasing number of patients with opioid use disorder (OUD) are treated with opioid agonist-antagonists such as buprenorphine/naloxone. Perioperative management of patients on buprenorphine/naloxone is inconsistent and remains a controversial topic with mismanagement posing a significant risk to the long-term health of these patients.

Methods

We performed a systematic literature search involving Medline, Medline In-Process, Embase, Cochrane Central, Cochrane Database of Systematic Reviews, PsycINFO, Web of Science (Clarivate), Scopus (Elsevier), CINAHL (EbscoHosst), and PubMed (NLM).

Results

Eighteen studies were included in the final sample, including one controlled study and four observational studies . Neither the controlled study nor the observational studies assessed addiction treatment retention, harm reduction, or long-term mortality rates as primary or secondary outcomes. Of the observational studies, authors showed equivalent peri- and postoperative pain control among buprenorphine continued patients. All but one authors described adequate analgesia among the case reports in which buprenorphine ≤ 16 mg sublingually (SL) daily was continued during the perioperative period. Long-term harm reduction was not reported with only three case reports including any long-term abstinence or relapse rates.

Conclusions

The current understanding of the risks and benefits of continuing or stopping buprenorphine perioperatively is limited by a lack of high-quality evidence. Observational studies and case reports indicate no evidence against continuing buprenorphine perioperatively, especially when the dose is < 16 mg SL daily. In patients with significant potential for relapse, such as those with a recent history of OUD, the discontinuation of buprenorphine should have a strong rationale supported by patient and surgical preferences. Future studies require standardized reporting of median doses, details on the route of delivery, dosing schedules and any dosing changes, and rates of addiction relapse, including long-term morbidity and mortality where possible.

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Metadata
Title
The perioperative patient on buprenorphine: a systematic review of perioperative management strategies and patient outcomes
Authors
Akash Goel, MD
Saam Azargive, MSc
Wiplove Lamba, MD
Joel Bordman, MD, DAAPM
Marina Englesakis, BA, MLIS
Sanjho Srikandarajah, MD
Karim Ladha, MD, MSc
Tania Di Renna, MD
Harsha Shanthanna, MD, MSc
Scott Duggan, MD, MSc
Philip Peng, MBBS
John Hanlon, MD, MSc
Hance Clarke, MD, PhD
Publication date
01-02-2019
Publisher
Springer International Publishing
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 2/2019
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-018-1255-3

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