2026-2027 | Live Session | Perioperative Care of Patients with Opioid Use Disorder | September 2026-Perioperative Care of Patients with Opioid Use Disorder Presentation

Perioperative Care of Patients with Opioid Use Disorder Presentation

Pdf Summary

This lecture reviewed perioperative pain management for patients with opioid use disorder, especially those taking buprenorphine or methadone. The central message was: generally, do not stop buprenorphine or methadone for surgery unless there is a compelling reason, and avoid letting surgical teams change these medications without coordination.<br /><br />The presentation contrasted older guidelines, which often recommended stopping buprenorphine before surgery, with newer evidence and expert consensus favoring continuation or dose reduction in selected cases. Multiple retrospective studies and a meta-analysis suggested that continuing buprenorphine is associated with equal or better pain control, lower opioid requirements, and less postoperative opioid dispensing compared with holding it. The 2020 ASAM update and 2021 multisociety recommendations support individualized decision-making, often in consultation with surgery, anesthesia, and addiction medicine.<br /><br />Pain control should be multimodal. Recommended strategies included scheduled acetaminophen and NSAIDs when appropriate, regional or neuraxial anesthesia, gabapentinoids, ketamine, alpha-2 agonists such as clonidine or dexmedetomidine, intravenous lidocaine, glucocorticoids, magnesium, and opioids when needed. Full opioid agonists can still work on top of buprenorphine or methadone, but higher-than-usual doses are often required. Hydromorphone or fentanyl may be useful, though evidence is limited.<br /><br />The lecture emphasized practical opioid prescribing: use scheduled oral dosing when possible, avoid IV PRN boluses, use PCA if IV opioids are needed, and plan transitions early. For patients on long-term opioids or those using illicit fentanyl, substantial opioid tolerance means pain and withdrawal may both need treatment.<br /><br />Special scenarios included extended-release naltrexone, where opioid blockade can require very high opioid doses in monitored settings, and elective surgery cases where shared planning is essential. The overall goal was to control pain, prevent withdrawal, and reduce relapse risk through careful, coordinated perioperative care.

Keywords

perioperative pain management

opioid use disorder

buprenorphine

methadone

multimodal analgesia

regional anesthesia

opioid tolerance

postoperative pain control

naltrexone

relapse prevention