980 - Perioperative Pain Management in Patients on Extended-Release Buprenorphine – A Case Series

A 56-year-old female with opioid use disorder (OUD) and a right lower quadrant abdominal mass presented for her first buprenorphine depot (ER Buprenorphine) injection 2 weeks before planned mass resection. Considering the implications, communication was established between the buprenorphine and surgical providers to ensure the injection did not impact surgical approach and to develop a post-operative pain strategy with physiatry.  

A 71-year-old male with OUD who had been on ER Buprenorphine for three years presented for emergent surgical management of vascular compromise of his leg. Due to the emergent nature of the procedure, there was no communication between the buprenorphine prescriber and the operative team.  

Both patients had uncomplicated post-operative courses with pain adequately controlled using a multimodal approach which included full opioid agonists. 






Discussions: Physiatrists often manage post-operative pain as consultants or inpatient providers. Currently, there is no prospective data to guide how to best manage acute, post operative pain in patients with OUD on ER-buprenorphine. Previous case reports have discussed treatment after orthopedic surgery, but there are no reported cases of managing the pain in other surgeries. If feasible, pre-operative communication between the buprenorphine prescriber and surgical/post-operative pain team is important, to ensure that the injection will not interfere with the interventional approach, to minimize complications and optimize post operative pain control.  

Conclusions: Comprehensive pain management in both the inpatient and outpatient settings is a core component of the care physiatrists provide. With 1.7 million Americans on Suboxone for OUD, these cases expand the knowledge base to better inform pain management in patients on ER-buprenorphine undergoing abdominal, gynecologic, and vascular surgeries. This reinforces that patients on ER-buprenorphine do not need to stop injections prior to surgical interventions to allow for appropriate pain control.