How does preoperative buprenorphine treatment influence postoperative pain management strategies?
Buprenorphine is a partial mu-agonist and kappa-antagonist. Clinically, however, it behaves as a full mu-opioid agonist for analgesia and may have antihyperalgesic properties. It also has high opioid receptor affinity and slow offset kinetics, leading to concerns that the resultant blockade could interfere with effective acute pain management using other full mu-opioid agonists. As a result, conflicting recommendations exist as to whether high-dose buprenorphine should be continued or ceased in the perioperative period. The recommendations are (a) stop taking buprenorphine at least 72 hours prior the expected surgery, or (b) continue the buprenorphine therapy and administer significantly higher doses of opioid, as needed. Multimodal analgesia with adjuvants and regional techniques have important role in treating opioid tolerant patients.