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Background and Aims Introduction: Patients on long-term opioid therapy, such as buprenorphine, pose a significant challenge for perioperative pain management. Regional anesthesia has emerged as a preferred method of treatment for these patients.

Methods Case report: A 47-year-old patient with a history of long-term buprenorphine/naloxone (8mg/2mg)/12h therapy was admitted to hospital for total knee arthroplasty. After obtaining informed consent, it was agreed that the surgery would be done entirely under regional anesthesia. On the day of surgery, preemptive analgesia of paracetamol 1g orally was prescribed before the patient was transferred to the anesthesia preparation room. Standard ASA monitoring was established, and the patient was premedicated with 2mg of iv midazolam and 8mg of iv dexamethasone. Ultrasound- guided peripheral nerve blocks were performed using a total volume of 48 ml of both diluted and non-diluted 0.5% levobupivacaine, including iPACK, anterior femoral cutaneous nerve block and modified genicular block with inferolateral genicular nerve exclusion. In addition, a catheter was placed in the adductor canal at midvastus level, followed by spinal anesthesia administered at L4/L5 level. Postoperative analgesia in the ward was provided by bolus catheter doses of 15 ml of 0.2% ropivacaine/8h, iv paracetamol 1g/8h, and iv ketoprofen 100 mg/12h for two consecutive days.

Results Results: The maximum reported pain intensity on the day of surgery was VAS 2, VAS 3 on the first postoperative day, and VAS 0 on the second day, after which the catheter was removed.

Conclusions Conclusion: The combination of regional anesthesia techniques and non-opioid medications provided excellent analgesia for patient taking buprenorphine.