Cesarean Sections, Buprenorphine, Intrathecal Opioids & Pain Control – What to do?

Authors

Madeel A. Abdullah, MD, Department of Anesthesiology, Thomas Jefferson University Hospital, Jefferson Medical CollegeFollow
Michelle Beam, D.O., Department of Anesthesiology, Thomas Jefferson University Hospital, Jefferson Medical CollegeFollow
H. Jane Huffnagle, D.O., Department of Anesthesiology, Thomas Jefferson University Hospital, Jefferson Medical CollegeFollow
Suzanne Huffnagle, D.O., Department of Anesthesiology, Thomas Jefferson University Hospital, Jefferson Medical CollegeFollow
Michelle Mele, MD, Department of Anesthesiology, Thomas Jefferson University Hospital, Jefferson Medical CollegeFollow
Eugene R. Viscusi, MD, Department of Anesthesiology, Thomas Jefferson University Hospital, Jefferson Medical CollegeFollow

Document Type

Poster

Publication Date

5-15-2014

Comments

Presented at: SOAP (Society for Obstetrics Anesthesiology and Perinatology), Toronto Canada.

Abstract

Introduction

Suboxone^® is becoming a popular alternative to methadone maintenance in opioid abstinence. This population will likely expand in the future presenting a challenge for perioperative analgesia. Conventional pharmacology suggests that buprenorphine has a high binding affinity for the mu-opioid receptor (MOR), displacing any other opioid; and, only overcome by extremely high opioid doses. Hence recommendations are usually that buprenorphine should be discontinued before surgery so the MOR is available perioperatively. Buprenorphine is considered to have a “ceiling” analgesic effect rather than a classic opioid dose-response curve; it should not be effective for postoperative analgesia. This case supports an emerging concept that buprenorphine may provide acceptable analgesia and that discontinuation may not be the best practice. Further, dose adjustment of buprenorphine for postop analgesia may be possible.

Recommended Citation

Abdullah, MD, Madeel A.; Beam, D.O., Michelle; Huffnagle, D.O., H. Jane; Huffnagle, D.O., Suzanne; Mele, MD, Michelle; and Viscusi, MD, Eugene R., "Cesarean Sections, Buprenorphine, Intrathecal Opioids & Pain Control – What to do?" (2014). Department of Anesthesiology Faculty Papers. Paper 28.
https://jdc.jefferson.edu/anfp/28