Harborview Medical Center, Seattle, Washington. ORCID: https://orcid.org/0000-0003-4378-002X.
Clinical Nurse Practitioner, Harborview Medical Center, Seattle, Washington.
J Opioid Manag. 2022 Jan-Feb;18(1):7-15. doi: 10.5055/jom.2022.0689.
Literature supporting best practice of perioperative buprenorphine management for opioid use disorder is evolving with more recent studies trending toward maintenance of home dose. To guide treatment protocols at our institution, we evaluated patients taking medication for opioid use disorder (MOUD) undergoing similar surgeries. Patients were maintained on either their outpatient buprenorphine or methadone.
Data were collected on 46 patients maintained on buprenorphine MOUD who underwent surgery. A subset of these patients (n = 24) was compared with 24 patients maintained on methadone MOUD, matched on surgical procedure, admission date, age, and sex.
This is a retrospective matched control study.
An academic, tertiary, Level 1 trauma center.
Primary outcomes were post-operative opioid use and post-anesthesia care unit (PACU) length of stay.
No significant differences in demographic characteristics, physical status, comorbid psychiatric diagnoses, or illicit substance use history were observed between patient groups. A higher proportion of patients taking methadone was admitted due to infection (41.7 percent vs 16.7 percent, p = 0.031) and underwent nonelective surgery (75.0 percent vs 45.8 percent, p = 0.039). No significant differences were observed between patients taking buprenorphine versus methadone with respect to PACU length of stay, post-operative opioid consumption, time-to-transition to oral opioids, or discharge opioid prescriptions. Patients taking buprenorphine were more likely to receive intravenous lidocaine (25.0 percent vs 0.0 percent, p = 0.031) and ketamine (83.3 percent vs 54.2 percent, p = 0.039).
Findings from this study support accumulating evidence that patients should be maintained on buprenorphine MOUD throughout the perioperative period.
支持阿片类药物使用障碍围手术期布比卡因管理最佳实践的文献正在不断发展，最近的研究更倾向于维持家庭剂量。为了指导我们机构的治疗方案，我们评估了接受类似手术的服用阿片类药物药物使用障碍（MOUD）药物的患者。患者维持门诊布比卡因或美沙酮治疗。
收集了 46 名接受布比卡因 MOUD 手术的患者的数据。这些患者中有一部分（n=24）与 24 名接受美沙酮 MOUD 治疗的患者进行了比较，这些患者在手术程序、入院日期、年龄和性别上相匹配。
这是一项回顾性匹配对照研究。
一所学术性的、三级的、一级创伤中心。
主要结果是术后阿片类药物使用和麻醉后护理单元（PACU）的住院时间。
在患者组之间未观察到人口统计学特征、身体状况、合并精神科诊断或非法物质使用史的显著差异。服用美沙酮的患者更多地因感染（41.7%比 16.7%，p=0.031）和接受非选择性手术（75.0%比 45.8%，p=0.039）而入院。与服用美沙酮的患者相比，服用布比卡因的患者在 PACU 住院时间、术后阿片类药物消耗、过渡到口服阿片类药物的时间或出院阿片类药物处方方面没有显著差异。服用布比卡因的患者更有可能接受静脉注射利多卡因（25.0%比 0.0%，p=0.031）和氯胺酮（83.3%比 54.2%，p=0.039）。
这项研究的结果支持越来越多的证据表明，患者在围手术期应维持布比卡因 MOUD 治疗。
