Opioid use disorder

Opioid use disorder

Anesthetic relevance	High
Anesthetic management
Specialty	Pain
Signs and symptoms
Diagnosis
Treatment
Article quality
Editor rating	In development
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Provide a brief summary of this comorbidity here.

Anesthetic implications

Patient's with opioid use disorder on maintenance therapy with Suboxone (buprenorphine-naloxone) or methadone are at high risk of inadequately controlled pain post-procedure 2/2 low dosing or slow titration.

Pathophysiology

Buprenorphine is a partial mu-opioid receptor agonist and kappa-opioid receptor. It is associated with less opioid-induced hyperalgesia compared to other opioids.

Anesthetic management

Preoperative optimization

The dose of suboxone has implications for the risk of opioid tolerance and increased post-operative pain.

Non-opioid agents such as Tylenol and gabapentin. Gabapentin has been shown to promote drug-abstinence in patient on outpatient methadone therapy. A shared neuro-inflammatory and central sensitization process akin to that of neuropathic pain may explain the cross-benefit it has in patients with opioid-induced hyperalgesia.

Intraoperative management

Regional anesthesia techniques

Ketamine is a useful adjunct in

Postoperative management

Consider post-operative stay in the ICU for pain management and consultation of in-house pain service. Buprenorphine can be safely ordered at patient's reported dosing for post-operative pain management as it is unlikely to cause respiratory depression.

References

Compton P, Kehoe P, Sinha K, Torrington MA, Ling W. Gabapentin improves cold-pressor pain responses in methadone-maintained patients. Drug Alcohol Depend. 2010 Jun 1;109(1-3):213-9. doi: 10.1016/j.drugalcdep.2010.01.006. Epub 2010 Feb 16. PMID: 20163921; PMCID: PMC2875370.