Perioperative Continuation of Chronic Opioids and Buprenorphine - CME Paid Option-Perioperative Continuation of Chronic Opioids and Buprenorphine

Video Transcription

Video Summary

Rachel Duncan, a clinical pharmacist with the Compass Sharp program, provides a comprehensive overview of perioperative management for patients on chronic opioids and buprenorphine. Chronic pain affects nearly 25% of adults in the U.S., with a similar proportion of surgical patients on chronic opioid therapy and a surgical population including patients with opioid use disorder (OUD). Preoperative opioid use correlates with worse surgical outcomes, including higher pain levels, longer hospital stays, and increased readmissions. Key to better outcomes is thorough preoperative screening—including medication reconciliation and substance use assessment—to identify opioid or buprenorphine use.<br /><br />Rachel emphasizes continuing opioid and buprenorphine therapy perioperatively, avoiding abrupt tapers to prevent withdrawal. Buprenorphine's high affinity for opioid receptors necessitates special pain management tactics, including multimodal analgesia and collaboration with pain and addiction specialists. Institutional protocols should guide individualized care based on surgery type, opioid regimen, and patient-specific factors, allowing safe continuation or adjustment of opioids.<br /><br />Intraoperative and postoperative management focuses on multimodal analgesia, avoiding opioid overuse, and ensuring communication among the care team and with outpatient providers. Proper discharge planning includes safe opioid prescribing, educating on naloxone use, and ensuring follow-up. Case studies illustrate applying these principles, highlighting interdisciplinary collaboration and utilizing provided resources to improve patient care and outcomes for this high-risk population.

Keywords

perioperative management

chronic opioids

buprenorphine therapy

opioid use disorder

multimodal analgesia

preoperative screening

opioid prescribing