ABSTRACT
Background Buprenorphine use continues to grow for the management of opioid use disorder (OUD) and chronic pain management. In the face of this increase in use, perioperative buprenorphine management continues to have conflicting recommendations with no consensus on optimal management. We examined the effects of holding versus continuing perioperative buprenorphine in patients on chronic buprenorphine therapy to seek an answer to whether it should be continued or discontinued in the perioperative period. Methods Patients who were included in the study had surgery from 2011 to 2020 and had received buprenorphine within 30 days prior to their surgery, were admitted postoperatively for at least 48 hours, went to the postanesthesia care unit (PACU) immediately after surgery, and were successfully extubated. For these 275 patients, the included factors were age, gender, primary surgical service, anesthesia type, postoperative opioid use, preoperative regional block performed, and inpatient pain service (IPS) consultation. The analysis included differences between patients who had continued versus discontinued buprenorphine either preoperatively or postoperatively. Results A total of 275 patients were treated within 30 days of surgery with buprenorphine; of these, 147 (53.4%) patients continued buprenorphine, and 128 (46.6%) discontinued buprenorphine preoperatively. For patients who discontinued buprenorphine preoperatively, the mean days stopped before surgery was 3.5 days. Patients continuing buprenorphine preoperatively had a significantly lower postoperative opioid requirement. In addition, patients were significantly younger and more likely to be female and had fewer IPS consultations than those who discontinued buprenorphine. Buprenorphine was restarted postoperatively for 143 (52%) patients and held for 132 (48%) postoperatively. Conclusions The use of buprenorphine perioperatively was associated with significantly reduced oral morphine equivalent (OME) requirements postoperatively. Further research is needed to give definitive recommendations for whether to continue or discontinue buprenorphine prior to surgery.
ABSTRACT
Orthopedic procedures involving the hip have remained challenging for regional anesthesia given the complex innervation, painful nature contributing to difficulty positioning, and a desire to maintain mobility to hasten postoperative recovery. The revision total hip arthroplasty (THA) poses a greater challenge for an effective regional analgesia due to complex surgical approach, scarring from previous surgery and limited patient mobility. The quadratus lumborum (QL) block has demonstrated to provide effective analgesia for primary hip surgery in recent studies. The pericapsular nerve group (PENG) block has also shown to provide analgesia in patients with hip fractures. There is no standard of care regional anesthesia technique for hip surgeries, and the regional practice varies widely among anesthesia providers. This retrospective case series studied the effect of combining the QL with PENG block on the revision THA analgesia.
