ArticleBritish journal of anaesthesia2019
Perioperative Pain and Addiction Interdisciplinary Network (PAIN) clinical practice advisory for perioperative management of buprenorphine: results of a modified Delphi process.
Article in British journal of anaesthesia, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it, 55 citations in OpenAlex.
- Management of opioid use disorder, opioid withdrawal, and opioid overdose prevention in hospitalized adults: A systematic review of existing guidelines.Journal of hospital medicine · 2022Pooled it
- Opioid-induced analgesia among persons with opioid use disorder receiving methadone or buprenorphine: A systematic review of experimental pain studies.Drug and alcohol dependence · 2021Pooled it
- Ultrasound-guided mandibular nerve block combined with superficial cervical plexus nerve block in patients undergoing radical surgery for tongue canceron: a randomized controlled trial.BMC anesthesiology · 2025Trial
- Trial
- An Individualized, Interdisciplinary Approach to the Perioperative Care of Patients on Buprenorphine.Current pain and headache reports · 2026Review
- Ethical Dilemmas and Approaches to Acute Pain Management in Patients With Substance Use Disorders.Cureus · 2025Review
- Narrative review: Managing buprenorphine and opioid use disorder in the perioperative setting.Pain practice : the official journal of World Institute of Pain · 2025Review
- How Do I Manage Acute Pain for Patients Prescribed Buprenorphine for Opioid Use Disorder?NEJM evidence · 2024Review
- Classifying the Factors Affecting Information Therapy to Support Clinical Decisions on Addiction.Addiction & health · 2023Article
- ERAS Protocol Options for Perioperative Pain Management of Substance Use Disorder in the Ambulatory Surgical Setting.Current pain and headache reports · 2023Review
- Acute Pain Management Pearls: A Focused Review for the Hospital Clinician.Healthcare (Basel, Switzerland) · 2022Review
- Perioperative Opioids, the Opioid Crisis, and the Anesthesiologist.Anesthesiology · 2022Article
- Elective surgery for acute pain in patients with substance use disorder: lessons learned at a rural neurosurgical center. Patient series.Journal of neurosurgery. Case lessons · 2022Article
- Continuation Versus Discontinuation of Buprenorphine in the Perioperative Setting: A Retrospective Study.Cureus · 2022Article
- Beyond opioid prescribing: Evaluation of a substance use disorder curriculum for OBGYN residents.PloS one · 2022Article
- Experiences with an addiction consultation service on care provided to hospitalized patients with opioid use disorder: a qualitative study of hospitalists, nurses, pharmacists, and social workers.Substance abuse · 2022Article
- Raw and processed electroencephalography in modern anesthesia practice: a brief primer on select clinical applications.Korean journal of anesthesiology · 2021Review
- Advanced Inpatient Management of Opioid Use Disorder in a Patient Requiring Serial Surgeries.Journal of general internal medicine · 2021Article
- Perioperative Pain Management and Opioid Stewardship: A Practical Guide.Healthcare (Basel, Switzerland) · 2021Review
- Managing Acute Pain in Patients Taking Medication for Opioid Use Disorder: a Rapid Review.Journal of general internal medicine · 2020Review
Corrections and comments
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Authors and funding
25 authors at 10 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Until recently, the belief that adequate pain management was not achievable while patients remained on buprenorphine was the impetus for the perioperative discontinuation of buprenorphine. We aimed to use an expert consensus Delphi-based survey technique to 1) specify the need for perioperative guidelines in this context and 2) offer a set of recommendations for the perioperative management of these patients. The major recommendation of this practice advisory is to continue buprenorphine therapy in the perioperative period. It is rarely appropriate to reduce the buprenorphine dose irrespective of indication or formulation. If analgesia is inadequate after optimisation of adjunct analgesic therapies, we recommend initiating a full mu agonist while continuing buprenorphine at some dose. The panel believes that before operation, physicians must distinguish between buprenorphine use for chronic pain (weaning/conversion from long-term high-dose opioids) and opioid use disorder (OUD) as the primary indication for buprenorphine therapy. Patients should ideally be discharged on buprenorphine, although not necessarily at their preoperative dose. Depending on analgesic requirements, they may be discharged on a full mu agonist. Overall, long-term buprenorphine treatment retention and harm reduction must be considered during the perioperative period when OUD is a primary diagnosis. The authors recognise that inter-patient variability will require some individualisation of clinical practice advisories. Clinical practice advisories are largely based on lower classes of evidence (level 4, level 5). Further research is required in order to implement meaningful changes in practitioner behaviour for this patient group.
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