2026-2027 | On-Demand Session | Perioperative Care of Patients with Opioid Use Disorder | September 2026-Perioperative Care of Patients with Opioid Use Disorder Recording

Video Transcription

Video Summary

Dr. Jim Walsh presented a didactic on perioperative care of patients with opioid use disorder, emphasizing that buprenorphine should generally be continued through surgery rather than stopped. He reviewed older guidance that recommended tapering or discontinuation, then contrasted it with newer evidence and guidelines showing that continuing buprenorphine is associated with less pain, lower opioid requirements, and better overall outcomes.<br /><br />He explained that pain can still be treated effectively despite receptor occupancy by using higher-than-usual doses of full opioid agonists, especially hydromorphone, and by favoring oral, scheduled, and frequent dosing when possible. For severe pain or major surgery, he discussed PCA use, epidural/spinal opioids, and careful transitions from IV to oral regimens.<br /><br />A major focus was multimodal analgesia. He reviewed the role of scheduled acetaminophen and NSAIDs, regional anesthesia, gabapentin or pregabalin, ketamine, alpha-2 agonists like clonidine or dexmedetomidine, and intravenous lidocaine. He stressed that these agents can reduce opioid needs and improve recovery, especially in high-pain surgeries or patients with opioid tolerance.<br /><br />Through clinical cases, Dr. Walsh highlighted practical management strategies for patients on methadone, buprenorphine, and even extended-release naltrexone, as well as for chronic pain patients on prescribed opioids. He repeatedly emphasized communication with surgeons, anesthesiologists, and outpatient prescribers, and the importance of affirming and supporting patients rather than disrupting stable treatment.

Keywords

buprenorphine

opioid use disorder

perioperative care

multimodal analgesia

pain management

hydromorphone

methadone

naltrexone

regional anesthesia

patient-controlled analgesia

acetaminophen

NSAIDs

ketamine

dexmedetomidine

opioid tolerance