Slinchenkova Kateryna, Medrano Elilary Montilla, Yedlin Adam S, Anand Preeti, Gritsenko Karina, Steinberg Sofia, Breidenbach Kathryn, Koushik Sarang, Raghavan Jagun, Viswanath Omar, Shaparin Naum
New York Medical College.
Anesthesiology Montefiore Medical Center, Albert Einstein College of Medicine.
Orthop Rev (Pavia). 2024 Dec 21;16:124776. doi: 10.52965/001c.124776. eCollection 2024.
Opioid use disorder is a chronic illness with significant morbidity and mortality. Opioid agonists, like buprenorphine, are commonly used to prevent relapse. Recent changes in buprenorphine legislation are expected to increase prescription and guidelines recommend its continuation during the perioperative period for many patients. However, buprenorphine's strong affinity for mu receptors can complicate perioperative pain management, requiring high doses of analgesics and increasing risks like respiratory depression. A newly FDA-approved sublingual sufentanil system, with higher mu receptor affinity, may offer a solution.
A series of three cases with patients undergoing outpatient surgery procedures while continuing buprenorphine treatment are presented.
Sublingual sufentanil was effective in lowering pain with no adverse effects for the buprenorphine patients undergoing surgery with general anesthesia without a missed dose.
Further research is needed to make conclusive remarks on the efficacy of this treatment, but the quick onset and effective treatment make this route worthwhile to consider.
阿片类物质使用障碍是一种具有显著发病率和死亡率的慢性疾病。阿片类激动剂，如丁丙诺啡，常用于预防复发。近期丁丙诺啡立法的变化预计会增加其处方量，并且指南建议许多患者在围手术期持续使用。然而，丁丙诺啡对μ受体的强亲和力会使围手术期疼痛管理复杂化，需要高剂量的镇痛药，并增加呼吸抑制等风险。一种新获得美国食品药品监督管理局（FDA）批准的舌下舒芬太尼系统，具有更高的μ受体亲和力，可能提供一种解决方案。
介绍了三例在继续接受丁丙诺啡治疗的同时接受门诊手术的患者。
舌下舒芬太尼对接受全身麻醉手术且未漏服剂量的丁丙诺啡患者有效降低了疼痛，且无不良反应。
需要进一步研究才能对该治疗的疗效做出确凿评价，但起效迅速且治疗有效使得该途径值得考虑。
