Thread by @SaraJPharmD

Happy Holidays! I'm starting a #FOAMed gift exchange.

My gift to #MedTwitter is-

🎁5 reasons to continue your patient's #buprenorphine perioperatively!🎁

1) Turns out bup is a great analgesic, and is actually unlikely to have a ceiling dose for analgesia. Abruptly stopping someone's basal analgesic + inflicting painful stimulus = poor postop pain control!

pubmed.ncbi.nlm.nih.gov/29624528/
pubmed.ncbi.nlm.nih.gov/16547090/
pubmed.ncbi.nlm.nih.gov/20492579/

2) Furthermore, bup's unique receptor profile affords a ceiling dose for resp depression, likely adding safety in the high-risk postop period. Changing to only pure mu agonists instead likely ⬆️risk for AEs

pubmed.ncbi.nlm.nih.gov/29452378/
pubmed.ncbi.nlm.nih.gov/16547090/
pubmed.ncbi.nlm.nih.gov/20492579/

3) Bup ⬇️opioid-induced hyperalgesia (OIH), poss by kappa antagonism. Very beneficial to postop pain control in the opioid-tolerant- Pts report ⬆️pain + need ⬆️opioids to control pain w/out bup maintenance!

pubmed.ncbi.nlm.nih.gov/32827109/
pubmed.ncbi.nlm.nih.gov/23530789/
pubmed.ncbi.nlm.nih.gov/31792832/

4) Stopping bup requires reinitiation after an opioid-free period subsequent to surgical pain recovery. This is logistically challenging, and incredibly painful and destabilizing for pts, likely increasing the risk for relapse.

pubmed.ncbi.nlm.nih.gov/29452378/
pubmed.ncbi.nlm.nih.gov/30500943/

5) We now have practice guidelines recommending this approach! While randomized data are limited, expert opinion based on available lit is to continue bup perioperatively, for multiple reasons.

ncbi.nlm.nih.gov/pmc/articles/P…
pubmed.ncbi.nlm.nih.gov/30768461/

Hope you like your gift! Not what you wanted? Feel free to re-gift or send your own😄 #FOAMedGiftExchange2020