Perioperative Care of Patients with Opioid Use Disorder (2025-2026 Recording)-Perioperative Care of Patients with Opioid Use Disorder Recording

Video Transcription

Video Summary

This lecture focused on perioperative pain management for patients with opioid use disorder, especially those on buprenorphine or methadone. The central message was: do <strong>not</strong> routinely stop or reduce buprenorphine. Older guidelines often recommended discontinuation before surgery, but newer evidence shows stopping it leads to <strong>worse pain control and higher opioid requirements</strong>. The speaker emphasized advocating for patients, communicating with surgeons/anesthesia teams, and being available to help manage pain.

Key strategies included <strong>multimodal analgesia</strong>: scheduled acetaminophen, NSAIDs when safe, gabapentin/pregabalin, ketamine in low-dose infusion, alpha-2 agonists like clonidine/tizanidine, regional anesthesia, lidocaine patches, magnesium, and—in selected settings—IV lidocaine or neuraxial techniques. These methods reduce opioid needs and improve recovery.

When opioids are needed, the lecture stressed that patients on buprenorphine or methadone often require <strong>higher-than-usual doses</strong>, but not necessarily for longer duration. Oral opioids are preferred over IV when possible, and <strong>scheduled dosing is better than PRN</strong> to avoid peaks, troughs, reinforcement, and conflict with nursing staff. PCA can be useful, but doses may need adjustment for opioid-tolerant patients.

Several cases illustrated practical application: converting PCA hydromorphone to oral dosing after C-section, treating withdrawal and pain in a fentanyl-using patient with methadone and adjuncts, managing pain in a patient on depot naltrexone, and coordinating postoperative opioids for a chronic pain patient on long-term morphine.

The lecture ended with the major takeaways: <strong>keep MOUD on board, use multimodal analgesia, prefer PO and scheduled meds, and communicate clearly with all teams and the patient.</strong>

Keywords

perioperative pain management

opioid use disorder

buprenorphine

methadone

multimodal analgesia

scheduled dosing

opioid tolerance

regional anesthesia

ketamine infusion

postoperative pain

medication for opioid use disorder