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Buprenorphine management: a conundrum for the anesthesiologist and beyond - a one-act play
  1. Shilen Thakrar1,
  2. Josh Lee1,
  3. Caitlin E Martin2,3 and
  4. John Butterworth IV1
  1. 1Department of Anesthesiology, VCU Medical Center, West Hospital,1200 E. Broad Street, 7th Floor. North Wing, Richmond, Virginia, USA
  2. 2Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia, USA
  3. 3Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
  1. Correspondence to Dr Shilen Thakrar, Anesthesiology, VCU Medical Center Main Hospital, Richmond, VA 23298-5051, USA; spthakrar{at}


We have witnessed a worldwide upsurge of streamlined enhanced recovery after surgery (ERAS) pathways advocating for consistency and compliance within their guidelines. At a recent national conference, two experts defended their institutional policies on perioperative management of buprenorphine, one defending its continuation, while the other suggesting its discontinuation. The moderator diplomatically proclaimed the need to have guidance at the institutional level and following it for favorable patient outcomes. Unfortunately, perioperative management of buprenorphine remains an understudied topic with a lack of national guidelines leading to variations at a local level despite its increased use nationally in the current opioid crisis. Although the moderator made a valid statement, we demonstrate via our one-act play the importance of recognizing a subset of the population within an ERAS pathway that necessitates multidisciplinary discussion, communication, and patient-centric care to formulate a perioperative plan coordinating a patient’s care. More robust research is needed to minimize variability in current practices and to further develop comprehensive evidence-based guidelines that encompass risk factors and anticipated postsurgical and peripartum pain for patients on buprenorphine.

  • acute pain
  • postoperative pain
  • pain medicine
  • pharmacology: other
  • opioids, adverse effects

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  • Contributors ST wrote the initial draft of the document. JL provided the original algorithm in the form of Figure 1. CM offered her expert opinion, as an addictionologist, and made corrections to the document. JB inspired us to write the document and made the necessary addendum.

  • 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.

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