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Original article
Implications of uninterrupted preoperative transdermal buprenorphine use on postoperative pain management
  1. Yvette N Martin1,
  2. Amy C S Pearson1,2,
  3. John R Tranchida1,
  4. Toby N Weingarten1,
  5. Phillip J Schulte3 and
  6. Juraj Sprung1
  1. 1 Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Department of Anesthesia, University of Iowa Health Care, Iowa City, Iowa, USA
  3. 3 Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Juraj Sprung, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, USA; sprung.juraj{at}mayo.edu

Abstract

Background and objectives Buprenorphine is a partial µ-receptor agonist resistant to displacement from receptors by conventional opioids, which can block the effect of conventional opioids and may interfere with postoperative pain management. We aimed to quantify perioperative opioid use in patients receiving transdermal buprenorphine (TdBUP).

Methods We identified patients receiving TdBUP who underwent surgery between 2004 and 2016. To compare opioid requirements (intravenous morphine equivalents (IV-MEq)), we constructed a matched study, matching each TdBUP patient with two opioid-naive patients by sex, age, and type of anesthesia and procedure.

Results Nineteen unique patients underwent 22 procedures while receiving TdBUP. Total (IQR) amounts of IV-MEq (intraoperative, recovery room, and 24 hours after recovery-room discharge) were 98 (63, 145) and 46 (30, 65) mg IV-MEq for TdBUP and opioid-naive patients, respectively (p<0.001). Postoperative IV-MEq requirements were 54 (38, 90) and 15 (3, 35) mg for TdBUP and opioid-naive patients, respectively (p<0.001). Among TdBUP patients, higher preoperative doses of TdBUP were associated with greater postoperative opioid requirements (p=0.02). Specifically, patients with a 20 µg/hour TdBUP patch required 133.8 mg IV-MEq more postoperatively than patients with a 5 µg/hour patch (p=0.002). Following discharge from the recovery room, 17 (77%) TdBUP patients and 15 (34%) opioid-naive patients reported severe pain (OR 6.6 (95% CI 2.0 to 21.3); p<0.001; adjusting for baseline pain score, 5.0 (95% CI, 1.4 to 17.8); p=0.01).

Conclusions Analgesic management for patients receiving TdBUP therapy must account for increased opioid needs, and greater preoperative doses of TdBUP were associated with greater postoperative opioid requirements.

  • anesthesia
  • buprenorphine
  • transdermal
  • opioid resistance
  • opioids
  • pain
  • surgery

https://doi.org/10.1136/rapm-2018-100018

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    Footnotes

    • Contributors YNM, ACSP and JRT collected the data. YNM drafted the manuscript. ACSP, JRT, TNW and JS contributed to the interpretation of data. ACSP, JRT, TNW and PJS contributed to the critical revisions of the work for important intellectual content. PJS performed statistical analysis. JS contributed to the conception and design of the work and study supervision. All authors contributed to the final approval of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Mayo Clinic Institutional Review Board. Consistent with Minnesota Statute 144.335 Subd. 3a. (d)

    • Provenance and peer review Not commissioned; externally peer reviewed.

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