26: Should buprenorphine be discontinued preoperatively?

26: Should buprenorphine be discontinued preoperatively?

Dr. Tony Anderson, an anesthesiologist at the Stanford University School of Medicine, joins us to discuss the evolving literature and evidence around perioperative management of buprenorphine.

Special thanks to Dr. Ashwini Joshi for her assistance with researching for the episode.

Thanks for listening!

If you enjoy our content, leave a 5-star review on Apple Podcasts and consider helping us offset the costs of production by donating through our Patreon at https://bit.ly/3n0sklh.

Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates.

Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team.

Music by Stephen Campbell, MD.

References

Anderson TA, Quaye ANA, Ward EN, Wilens TE, Hilliard PE, Brummett CM. To Stop or Not, That Is the Question: Acute Pain Management for the Patient on Chronic Buprenorphine. Anesthesiology. 2017 Jun;126(6):1180-1186. doi: 10.1097/ALN.0000000000001633. PMID: 28511196; PMCID: PMC7041233.

Goel A, Azargive S, Lamba W, Bordman J, Englesakis M, Srikandarajah S, Ladha K, Di Renna T, Shanthanna H, Duggan S, Peng P, Hanlon J, Clarke H. The perioperative patient on buprenorphine: a systematic review of perioperative management strategies and patient outcomes. Can J Anaesth. 2019 Feb;66(2):201-217. English. doi: 10.1007/s12630-018-1255-3. Epub 2018 Nov 27. PMID: 30484167.

Goel A, Azargive S, Weissman JS, Shanthanna H, Hanlon JG, Samman B, Dominicis M, Ladha KS, Lamba W, Duggan S, Di Renna T, Peng P, Wong C, Sinha A, Eipe N, Martell D, Intrater H, MacDougall P, Kwofie K, St-Jean M, Rashiq S, Van Camp K, Flamer D, Satok-Wolman M, Clarke H. Perioperative Pain and Addiction Interdisciplinary Network (PAIN) clinical practice advisory for perioperative management of buprenorphine: results of a modified Delphi process. Br J Anaesth. 2019 Aug;123(2):e333-e342. doi: 10.1016/j.bja.2019.03.044. Epub 2019 May 29. PMID: 31153631; PMCID: PMC6676043.

Hansen LE, Stone GE, Matson CA, Tybor DJ, Pevear ME, Smith EL. Total joint arthroplasty in patients taking methadone or buprenorphine/naloxone preoperatively for prior heroin addiction: a prospective matched cohort study. J Arthroplasty 2016; 31: 1698-701. (29)

Höflich AS, Langer M, Jagsch R, Bäwert A, Winklbaur B, Fischer G, Unger A. Peripartum pain management in opioid dependent women. Eur J Pain. 2012 Apr;16(4):574-84. doi: 10.1016/j.ejpain.2011.08.008. PMID: 22396085; PMCID: PMC3290684.

Li A, Schmiesing C, Aggarwal AK.Evidence for Continuing Buprenorphine in the Perioperative Period. Clin J Pain. 2020 Oct; 36(10): 764-774.doi: 10.1097/AJP.0000000000000858. PMID: 32520814

Macintyre PE, Russel RA, Usher KA, Gaughwin M, Huxtable CA. Pain relief and opioid requirements in the first 24 hours after surgery in patients taking buprenorphine and methadone opioid substitution therapy. Anaesth Intensive Care 2013; 41: 222-30 (27)

Meyer M, Paranya G, Keefer Norris A, Howard D. Intrapartum and postpartum analgesia for women maintained on buprenorphine during pregnancy. Eur J Pain. 2010 Oct;14(9):939-43. doi: 10.1016/j.ejpain.2010.03.002. Epub 2010 May 4. PMID: 20444630.

Quaye A, Potter K, Roth S, Acampora G, Mao J, Zhang Y. Perioperative Continuation of Buprenorphine at Low-Moderate Doses Was Associated with Lower Postoperative Pain Scores and Decreased Outpatient Opioid Dispensing Compared with Buprenorphine Discontinuation. Pain Med. 2020 Sep 1;21(9):1955-1960. doi: 10.1093/pm/pnaa020. PMID: 32167541.

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41: Do pulmonary artery catheters improve outcomes in cardiac surgery?

41: Do pulmonary artery catheters improve outcomes in cardiac surgery?

Dr. Taylor Thomas and Dr. Matt Vanneman join the podcast to discuss the evidence on whether pulmonary artery catheters improve outcomes in cardiac surgery. Dr. Thomas is a dual obstetric and adult car...

26 Okt 202532min

40: Are peripartum opioids safe for breastfeeding mothers?

40: Are peripartum opioids safe for breastfeeding mothers?

Dr. Gopika Hari and Dr. Lana Joudeh join the podcast to discuss the literature on the safety of peripartum opioid use and its implications for breastfeeding. Dr. Hari is an anesthesia resident in the ...

9 Apr 202541min

39: Should opioid-free anesthesia be implemented? A Pro-Con Debate.

39: Should opioid-free anesthesia be implemented? A Pro-Con Debate.

Dr. Mary Daniels and Dr. Scott Cao join the show to discuss the literature surrounding opioid-free versus opioid-based anesthesia and analgesia techniques. Dr. Scott Cao is currently serving as a chie...

10 Jan 202525min

38: Does remifentanil cause opioid-induced hyperalgesia?

38: Does remifentanil cause opioid-induced hyperalgesia?

Dr. Jess Hawkins joins the show to discuss the literature pertaining to remifentanil and opioid-induced hyperalgesia. Dr. Hawkins is an anesthesia resident at the Massachusetts General Hospital. This ...

23 Sep 202428min

37: Should intraoperative dexamethasone be avoided in patients with diabetes mellitus?

37: Should intraoperative dexamethasone be avoided in patients with diabetes mellitus?

Dr. Caroline Andrew and Dr. David Nathan join the show to discuss the literature pertaining to intraoperative administration of dexamethasone. Dr. Caroline Andrew is an anesthesia resident at the Mass...

1 Mai 202441min

36. Does tranexamic acid increase the risk of thromboembolism?

36. Does tranexamic acid increase the risk of thromboembolism?

Dr. Zach Cost and Dr. Tem Bendapudi join the show to discuss the literature pertaining to tranexamic acid and thromboembolic risk. Dr. Zach Cost is an anesthesia resident at the Massachusetts General ...

6 Des 20231h

35. Does spinal anesthesia decrease the risk of postoperative delirium?

35. Does spinal anesthesia decrease the risk of postoperative delirium?

Dr. Mark Neuman and Dr. Sam Falkson join the show to discuss the literature around risks of regional versus general anesthesia for postoperative delirium. Dr. Neuman is the founding Director of the Ce...

30 Jul 202358min

34. Are double lumen endotracheal tubes superior to bronchial blockers?

34. Are double lumen endotracheal tubes superior to bronchial blockers?

Dr. Nick Kumar and Dr. Andy Siemens from the Massachusetts General Hospital anesthesia residency join the show to discuss the literature comparing double lumen endotracheal tubes and bronchial blocker...

2 Apr 202346min

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