Quaye Aurora, Potter Kevin, Roth Sarah, Acampora Gregory, Mao Jianren, Zhang Yi
Massachusetts General Hospital, Boston, Massachusetts.
Maine Medical Center, Portland, Maine, USA.
Pain Med. 2020 Sep 1;21(9):1955-1960. doi: 10.1093/pm/pnaa020.
An increasing number of individuals are prescribed buprenorphine as medication-assisted treatment for opioid use disorder. Our institution developed guidelines for perioperative buprenorphine continuation with an algorithm for dose reduction based upon the surgical procedure and patient's maintenance dose. The objective of this study was to compare the effects of buprenorphine continuation with those of discontinuation on postoperative pain scores and outpatient opioid dispensing.
Retrospective observational study.
Surgical patients on buprenorphine from March 2018 to October 2018. Patients on buprenorphine for chronic pain and those with minor procedures were excluded from analysis.
We compared postoperative outpatient opioid dispensing and postanesthesia care unit (PACU) pain scores in patients where buprenorphine was continued compared with held perioperatively, collecting single surgical subspecialty prescriber data on outpatient full mu-opioid agonist prescriptions dispensed, converted into mean morphine equivalents. Buprenorphine formulations were not included in our morphine milligram equivalents (MME) total.
There were 55 patients total (38 cont. vs 17 held). There was no difference in postoperative buprenorphine treatment adherence (91% cont. vs 88% held, P = 0.324). The number of opioid prescriptions dispensed was significantly higher with buprenorphine discontinuation (53% cont. vs 82% held, P = 0.011), as was MME dispensed (mean of 229 cont. vs mean of 521 held, P = 0.033). PACU pain scores were higher with buprenorphine discontinuation (mean 2.9 cont. vs mean 7.6 held, P < 0.001).
There was a significant reduction in opioid prescriptions filled, MME dispensed, and PACU pain scores in patients where buprenorphine was continued vs held perioperatively. We provide evidence to support that buprenorphine can be continued perioperatively and that continuation is associated with decreased postoperative pain and decreased outpatient opioid dispensing. These results contribute to the existing literature supporting the perioperative continuation of buprenorphine.
越来越多的人被开具丁丙诺啡作为阿片类物质使用障碍的药物辅助治疗。我们机构制定了围手术期继续使用丁丙诺啡的指南，并根据手术程序和患者维持剂量制定了剂量减少算法。本研究的目的是比较继续使用丁丙诺啡与停用丁丙诺啡对术后疼痛评分和门诊阿片类药物配给量的影响。
回顾性观察研究。
2018年3月至2018年10月期间服用丁丙诺啡的手术患者。因慢性疼痛服用丁丙诺啡的患者和接受小手术的患者被排除在分析之外。
我们比较了围手术期继续使用丁丙诺啡与停用丁丙诺啡的患者术后门诊阿片类药物配给量和麻醉后护理单元（PACU）疼痛评分，收集了单一外科亚专业开处方者关于门诊全μ阿片类激动剂处方配给量的数据，并换算为平均吗啡当量。丁丙诺啡制剂未纳入我们的吗啡毫克当量（MME）总数中。
总共有55例患者（38例继续使用 vs 17例停用）。术后丁丙诺啡治疗依从性无差异（继续使用组为91%，停用组为88%，P = 0.324）。停用丁丙诺啡时阿片类药物处方配给量显著更高（继续使用组为53%，停用组为82%，P = 0.011），MME配给量也是如此（继续使用组平均为229，停用组平均为521，P = 0.033）。停用丁丙诺啡时PACU疼痛评分更高（继续使用组平均为2.9，停用组平均为7.6，P < 0.001）。
与围手术期停用丁丙诺啡的患者相比，继续使用丁丙诺啡的患者在阿片类药物处方配给量、MME配给量和PACU疼痛评分方面有显著降低。我们提供证据支持围手术期可继续使用丁丙诺啡，且继续使用与术后疼痛减轻和门诊阿片类药物配给量减少相关。这些结果为支持围手术期继续使用丁丙诺啡的现有文献增添了内容。
