Perioperative Continuation of Chronic Opioids and Buprenorphine-FREE NO CME-Perioperative Continuation of Chronic Opioids

Video Transcription

Video Summary

Rachel Duncan, a clinical pharmacist, presents on managing perioperative continuation of chronic opioids and buprenorphine in surgical patients. Highlighting that nearly 25% of surgical patients are on chronic opioids and about 2% have opioid use disorder, she emphasizes the need for careful preoperative screening and medication reconciliation to optimize surgical outcomes. Chronic opioid use is linked to increased pain, longer hospital stays, higher readmission rates, and complications.<br /><br />Rachel discusses the pharmacology of methadone, buprenorphine, and naltrexone, underlining the importance of continuing methadone and buprenorphine perioperatively to avoid withdrawal and improve pain management, while naltrexone requires stopping before surgery. She advocates for standardized hospital policies to guide perioperative opioid management, stressing individualized plans based on surgery type, pain expectations, and patient factors.<br /><br />Effective practices include multimodal analgesia, thorough interprofessional collaboration involving anesthesia, pharmacy, pain specialists, and addiction services, plus clear discharge planning with outpatient follow-up and naloxone distribution. Patient education and shared decision-making are vital. Rachel illustrates these principles through case studies, demonstrating continuation of suboxone during surgery and managing naltrexone in an acute setting. Overall, successful perioperative opioid management demands preparation, communication, and protocols to improve outcomes and reduce complications in this high-risk population.

Keywords

perioperative opioid management

chronic opioid use

buprenorphine continuation

methadone pharmacology

naltrexone discontinuation

multimodal analgesia

interprofessional collaboration