Episode 130 - Perioperative Considerations Part 4: Management of Patients with or at Risk for Untreated OUD

Drs. Bell and DeVine return for Part 4 of Perioperative Considerations, Management, and Process for patients on buprenorphine. This final (for now) episode discusses the ‘other’ patient situations concerning perioperative times. How do you manage patients who have an undiagnosed opioid use disorder or are on very high doses of chronic opioids? What about patients who are opioid naive but who are high-risk for development of an OUD? These patients may be those who, personally, do not want opioids for any reason either due to a history of another substance use disorder or those who just do not want opioid exposure. Teaser- there will likely be a part 5 of this series of Perioperative Considerations… Below you will find the resources used for the development of this series. To learn more about the doctors as well as keep up with current happenings follow on twitter: @echocsct or email us with questions or feedback: [e-mail] Part of the Ars Longa Media Productions. Articles for Perioperative Series: •Bentzley BS et al. Discontinuation of buprenorphine maintenance therapy: perspectives and outcomes. J Subst Abuse Treat 2015;52:48-57. •Buresh M, et al. Treatment perioperative and acute pain in patients on buprenorphine: narrative literature review and practice recommendations. J Gen Intern Med 2020;35(12):3635-3643. •Champagne K, et al. Patients on buprenorphine formulations undergoing surgery. Current Pain and Headache Reports 2022;26:459-468. •Engle AL, et al. The divided dose approach to perioperative buprenorphine management in patients with opioid use disorder. Journal of Opioid Management 2021;17(7):101-107. •Evans E, et al. Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006-10. Addiction 2015;110:996. Goel A et al. The perioperative patient on buprenorphine: a systematic review of perioperative management strategies and patient outcomes. Can J Anaest 2019;66:201-17 •Greenwald M et al. Buprenorphine duration of action: mu-opioid receptor availability and pharmacokinetic and behavioral indices. Biol Psychiatry. 2007 Jan1;61(1):101-10. •Katz A, et al. Tobacco, alcohol, and drug use and willingness to change. J Hosp Med 2008;3:369-75. •Kubalanza K et al. Sublingual buprenorphine vs. morphine for acute pain. Am Fam Physician. 2012;86(7):682. •Liebschutz JM, et al. Buprenorphine treatment for hospitalized, opioid-dependent patients: a randomized clinical trial. JAMA Intern Med 2014;174:369-76. •Machado FC et al. Transdermal buprenorphine for acute postoperative pain: a systematic review. Braz J Anesthesiol. Jul-Aug 2020;70(4):419-428. Pergolizzi J et al. Current knowledge of buprenorphine and its unique pharmacological profile. Pain Pract. Sep-Oct 2010;10(5):428-50. Learn more about your ad choices. Visit megaphone.fm/adchoices