Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital/Harvard, Boston, MA.
Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital/Harvard, Boston, MA; Department of Anesthesiology, LSU School of Medicine, New Orleans, LA.
Pain Physician. 2018 Jan;21(1):E1-E12.
Starting with approval for clinical use in the treatment of opioid dependence in October 2002 by the Food and Drug Administration (FDA), buprenorphine has become an integral treatment option and in recent years, in chronic pain management. Buprenorphine possesses a unique pharmacodynamic and pharmacokinetic profile that can potentially make perioperative analgesia challenging.
To date no unified guidelines or recommendations are available for buprenorphine product management during the perioperative period. The present investigation aims to review the literature and provide recommendations when encountering a patient on buprenorphine therapy who is scheduled for a surgical or interventional pain procedure.
Clinical studies and reviews were searched using the PubMed National Center for Biotechnology Information database using MeSH terms buprenorphine, buprenorphine and naloxone, suboxone, perioperative, and postoperative pain.
PubMed National Center for Biotechnology Information database search resulted in one randomized control trial, one prospective case matched cohort, one retrospective cohort, 0 case series, 4 case reports, and 6 review articles. Key literature is reviewed and summarized.
Only 12 articles were included, which permits only limited recommendations drawn from this review.
The perioperative management of buprenorphine and buprenorphine/naloxone are dependent on several key factors. The nature of the surgery, namely the postoperative opioid requirement, elective versus emergency surgery, patient characteristics, formulation of buprenorphine, and indication for buprenorphine or buprenorphine/naloxone therapy must be considered when devising a plan. Several options exist when formulating a plan for the perioperative management, including continuing buprenorphine therapy or holding buprenorphine therapy for a defined period of time with or without bridging to alternative opioids. Additionally, social support people and patient motivation should be addressed and optimized, as well as nonopioid adjuvant therapy should be maximized as applicable to each patient undergoing a surgical or interventional pain procedure.
Buprenorphine, naloxone, surgery, pain management, anesthesia, suboxone, opioid abuse.
自 2002 年 10 月美国食品和药物管理局（FDA）批准用于治疗阿片类药物依赖的临床使用以来，丁丙诺啡已成为一种完整的治疗选择，近年来在慢性疼痛管理中也是如此。丁丙诺啡具有独特的药效学和药代动力学特征，这可能使围手术期镇痛具有挑战性。
迄今为止，尚无统一的丁丙诺啡产品管理指南或建议可用于围手术期。本研究旨在回顾文献，并在遇到接受丁丙诺啡治疗的患者，且该患者计划接受手术或介入性疼痛程序时提供建议。
使用 PubMed 国家生物技术信息中心数据库，使用 MeSH 术语丁丙诺啡、丁丙诺啡和纳洛酮、苏内奥酮、围手术期和术后疼痛，搜索临床研究和综述。
PubMed 国家生物技术信息中心数据库搜索结果为 1 项随机对照试验、1 项前瞻性病例匹配队列研究、1 项回顾性队列研究、0 项病例系列研究、4 项病例报告和 6 项综述文章。关键文献进行了回顾和总结。
仅纳入了 12 篇文章，因此只能从本次综述中得出有限的建议。
丁丙诺啡和丁丙诺啡/纳洛酮的围手术期管理取决于几个关键因素。手术的性质，即术后阿片类药物的需求、择期手术与急诊手术、患者特征、丁丙诺啡的剂型以及丁丙诺啡或丁丙诺啡/纳洛酮治疗的适应证，都必须在制定计划时加以考虑。在制定围手术期管理计划时，有几种选择，包括继续丁丙诺啡治疗或在规定时间内停止丁丙诺啡治疗，同时或不使用替代阿片类药物进行桥接。此外，还应解决和优化社会支持人员和患者的动机问题，并尽可能使每位接受手术或介入性疼痛程序的患者最大化非阿片类辅助治疗。
丁丙诺啡、纳洛酮、手术、疼痛管理、麻醉、苏内奥酮、阿片类药物滥用。
