Buprenorphine is a unique pharmaceutical in the management of chronic pain and opioid use disorder (OUD). Buprenorphine is a semisynthetic partial opioid agonist at the mu opioid receptor and an antagonist of the kappa opioid. Buprenorphine Maintenance Therapy (BMT) is utilized for the long-term treatment of patients with OUD. The attraction to this methadone alternative is increased safety profile, more convenient patient access to the drug, as well as increase of ease for the provider. The particular formula used in the US, Suboxone, has properties to discourage intravenous injection to prevent abuse and prevent negative secondary effects of intravascular injections in general. Buprenorphine, a partial agonist, has an affinity higher than that of a full agonist at the mu receptor. It has lower efficacy, slow offset, as well as a ceiling effect, making surgical analgesia difficult to control for those on a maintenance therapy. In the clinical setting, many opinions and theories have been discussed in the approach to managing perioperative pain for a patient on BMT. Use of buprenorphine is increasing, “nevertheless, there is limited and conflicting information in the literature pertaining to the optimal management of buprenorphine-stabilized patients presenting for surgery”. (Huang, Katznelson, Perrot, & Clark, 2014). In a search through the literature, there has been varying protocols and theories presented intertwined with case studies. The goal of this paper is to review buprenorphine and to discuss the current literature on the perioperative management for patients on a maintenance plan.
Stern, Elizabeth E., "Buprenorphine And The Anesthesia Considerations: A Literature Review" (2015). Nurse Anesthesia Capstones. 2.