Buprenorphine challenges in the perioperative period

Abstract

Derived from thebaine, an alkaloid found in the Papaver somniferum plant, buprenorphine is a semisynthetic, centrally acting, partial agonist for the opioid receptor. It is used clinically as an analgesic and more recently as opioid replacement therapy for the treatment of opioid dependence. Although methadone has historically been the agent of choice for the pharmacologic treatment of opioid abuse, buprenorphine has a more favorable safety profile and lower abuse potential. In low doses buprenorphine is a long-acting and easily administered analgesic for moderate pain. Potentially a treatment for opioid-induced hyperalgesia, buprenorphine offers promise for the treatment of chronic pain and opioid dependence. The prevalence of patients taking buprenorphine who present for surgical procedures is increasing as the prevalence of buprenorphine therapy rises. The same pharmacologic characteristics that make buprenorphine a safe and effective treatment option complicate perioperative pain management. Effective perioperative analgesia is possible in patients taking buprenorphine but requires expertise and awareness of the drug’s properties.