Buprenorphine and Cardiac Surgery: Navigating the Challenges of Pain Management
Fernando RJ, Graulein D, Hamzi RI, Augoustides JG, Khalil S, Sanders J, Sibai N, Hong TS, Kiwakyou LM, and Brodt JL. Buprenorphine and Cardiac Surgery: Navigating the Challenges of Pain Management. J Cardiothorac Vasc Anesth 2022; 36(9):3701-3708.
Journal of cardiothoracic and vascular anesthesia
Over the last two decades, buprenorphine has been used for the treatment of pain, opioid addiction, and detoxification. It has unique properties, including partial agonist activity at the mu receptor, while also exhibiting antagonism at the kappa receptor. The half-life is highly variable with each patient, but it may extend up to 60 hours. In addition, even low doses will outcompete other opioids to bind receptors, rendering other opioids ineffective unless very high doses are used. Although this may be advantageous in the outpatient setting, the pharmacokinetic and pharmacodynamic properties of buprenorphine can complicate the perioperative management of pain when these patients present for surgery. Herein, the authors present a case during which a patient who was started on buprenorphine for addiction therapy was referred subsequently for cardiac surgery during the same inpatient hospital admission.
Medical Subject Headings
Analgesics, Opioid; Buprenorphine; Cardiac Surgical Procedures; Humans; Nerve Block; Pain Management; Pain, Postoperative