Buprenorphine and Cardiac Surgery: Navigating the Challenges of Pain Management

OVER THE LAST 2 decades, buprenorphine has been used for the treatment of pain, opioid addiction, and detoxification. It has unique properties, including partial agonist activity at the mu receptor, while also exhibiting antagonism at the kappa receptor. 1 Goel A Azargive S Lamba W et al. The perioperative patient on buprenorphine: A systematic review of perioperative management strategies and patient outcomes. Can J Anaesth. 2019; 66: 201-217 Crossref PubMed Scopus (32) Google Scholar The half-life is highly variable with each patient, but it may extend up to 60 hours. In addition, even low doses will outcompete other opioids to bind receptors, rendering other opioids ineffective unless very high doses are used. 2 Anderson TA Quaye ANA Ward EN et al. To stop or not, that is the question: Acute pain management for the patient on chronic buprenorphine. Anesthesiology. 2017; 126: 1180-1186 Crossref PubMed Scopus (83) Google Scholar Although this may be advantageous in the outpatient setting, the pharmacokinetic and pharmacodynamic properties of buprenorphine can complicate the perioperative management of pain when these patients present for surgery. Herein, the authors present a case during which a patient who was started on buprenorphine for addiction therapy was referred subsequently for cardiac surgery during the same inpatient hospital admission.