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.
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.