From the Guidelines
You should not stop taking Suboxone (buprenorphine/naloxone) before surgery without consulting your healthcare provider, as most recent guidelines recommend continuing it throughout the perioperative period to prevent withdrawal and relapse 1.
Perioperative Management of Buprenorphine
The decision to continue or discontinue buprenorphine before surgery should be individualized to the patient and clinical circumstances, considering the prescribed daily dose, indication for treatment, risk of relapse, and expected level of postsurgical pain 1.
Key Considerations
- The partial opioid agonist properties of buprenorphine provide a baseline level of pain control while preventing withdrawal, and modern pain management protocols can work effectively around it.
- Stopping buprenorphine abruptly can lead to withdrawal symptoms and potential relapse to opioid use.
- For pain management during and after surgery, anesthesiologists and surgeons may need to use higher doses of full opioid agonists to overcome the partial blockade effect of buprenorphine.
Recent Guidelines
The most recent guidelines from the Society for Perioperative Assessment and Quality Improvement (SPAQI) recommend individualizing the decision to continue or hold buprenorphine based on patient-specific factors, rather than following a one-size-fits-all approach 1.
Clinical Implications
In clinical practice, it is essential to inform the healthcare team about Suboxone use well before surgery to develop an appropriate pain management plan.
- In some cases, tapering down the dose 24-72 hours before surgery may be considered, but this is becoming less common practice.
- After surgery, patients typically resume their regular Suboxone dosage once they no longer need additional pain medication.
Evidence-Based Practice
The evidence from recent studies, including the 2021 SPAQI consensus statement, supports the continuation of buprenorphine in the perioperative period, with individualized decision-making based on patient-specific factors 1.
Patient-Centered Care
Ultimately, the decision to continue or discontinue buprenorphine before surgery should be made in consultation with the patient's healthcare provider, taking into account their unique needs and circumstances.
From the Research
Perioperative Management of Buprenorphine
The question of whether Suboxone (buprenorphine) should be discontinued before surgery is a complex one, with various studies offering insights into its management in the perioperative setting.
- The general consensus, as indicated by studies 2, 3, 4, suggests that continuation of buprenorphine during the perioperative period is generally recommended to reduce the risk of opioid withdrawal, relapse, or inadequately controlled pain.
- A study published in 2019 5 found no significant difference in opioid requirements between patients who continued Suboxone until the day of surgery and those who discontinued it preoperatively.
- Another study from 2022 4 found that patients who continued buprenorphine preoperatively had a significantly lower postoperative opioid requirement, suggesting that continuation may be beneficial for pain management.
- The properties of buprenorphine, acting as a partial μ agonist and ĸ antagonist, make it an effective tool in treating opioid use disorder (OUD) and abuse, but can also make it difficult to control acute perioperative pain, as noted in a case report from 2020 6.
Key Findings
- Continuation of buprenorphine perioperatively is associated with reduced postoperative opioid requirements 4.
- No significant differences in pain scores or opioid requirements were found between patients who continued or discontinued buprenorphine preoperatively in some studies 5, 3.
- Buprenorphine can be safely continued or initiated for acute pain management during and after surgery, according to a review of the literature 2.
Considerations for Perioperative Care
- Physicians treating patients with Suboxone must be prepared to administer large doses of opioids during the early postoperative period, regardless of whether Suboxone is continued or discontinued 5.
- The decision to continue or discontinue buprenorphine should be made on a case-by-case basis, taking into account individual patient factors and the type of surgery being performed 4.