Perioperative Pain and Addiction Interdisciplinary Network (PAIN) clinical practice advisory for perioperative management of buprenorphine: results of a modified Delphi process
| Autor: | Tania Di Renna, Mary Dominicis, Kari Van Camp, Avinash Sinha, Peter MacDougall, Scott Duggan, John G. Hanlon, Akash Goel, David Flamer, Joel S. Weissman, Saifee Rashiq, Mireille St-Jean, Clinton L. Wong, David Martell, Philip Peng, Kwesi Kwofie, Bana Samman, Wiplove Lamba, Michael Satok-Wolman, Naveen Eipe, Karim S. Ladha, Harsha Shanthanna, Saam Azargive, Howard Intrater, Hance Clarke |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Perioperative Pain Assessment and Management Delphi Technique Analgesic Context (language use) Perioperative Care 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology medicine Humans Pain Management Intensive care medicine Harm reduction business.industry Chronic pain Opioid use disorder Perioperative Opioid-Related Disorders medicine.disease Buprenorphine Discontinuation Analgesics Opioid Anesthesiology and Pain Medicine Practice Guidelines as Topic Chronic Pain business medicine.drug |
| Zdroj: | British Journal of Anaesthesia. 123:e333-e342 |
| ISSN: | 0007-0912 |
| DOI: | 10.1016/j.bja.2019.03.044 |
| Popis: | Summary Until recently, the belief that adequate pain management was not achievable while patients remained on buprenorphine was the impetus for the perioperative discontinuation of buprenorphine. We aimed to use an expert consensus Delphi-based survey technique to 1) specify the need for perioperative guidelines in this context and 2) offer a set of recommendations for the perioperative management of these patients. The major recommendation of this practice advisory is to continue buprenorphine therapy in the perioperative period. It is rarely appropriate to reduce the buprenorphine dose irrespective of indication or formulation. If analgesia is inadequate after optimisation of adjunct analgesic therapies, we recommend initiating a full mu agonist while continuing buprenorphine at some dose. The panel believes that before operation, physicians must distinguish between buprenorphine use for chronic pain (weaning/conversion from long-term high-dose opioids) and opioid use disorder (OUD) as the primary indication for buprenorphine therapy. Patients should ideally be discharged on buprenorphine, although not necessarily at their preoperative dose. Depending on analgesic requirements, they may be discharged on a full mu agonist. Overall, long-term buprenorphine treatment retention and harm reduction must be considered during the perioperative period when OUD is a primary diagnosis. The authors recognise that inter-patient variability will require some individualisation of clinical practice advisories. Clinical practice advisories are largely based on lower classes of evidence (level 4, level 5). Further research is required in order to implement meaningful changes in practitioner behaviour for this patient group. |
| Databáze: | OpenAIRE |
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