Skip to main content

Buprenorphine, Buprenorphine/Naloxone (Suboxone)

  • Chapter
  • First Online:
First Aid Perioperative Ultrasound


Buprenorphine is a semi-synthetic opioid derived from a naturally-occurring alkaloid of the opium poppy known as thebaine. It is a mixed opioid agonist-antagonist with unique properties that has become a popular method to manage patients with chronic pain as well as those with opioid use disorder (OUD). Naloxone is included in some formulations to mitigate its abuse potential. Anesthesiologists should expect to more frequently encounter these patients perioperatively—in both operating room and procedural arenas. Perioperative pain management can prove difficult in this patient population. Understanding buprenorphine’s pharmacodynamic and pharmacokinetic properties will better prepare the anesthesiologist to manage these patients. This review will discuss those unique aspects of buprenorphine, as well as important considerations such as dose titration before painful procedures, multidisciplinary planning and multimodal analgesic strategies to provide the most safe and effective care when encountering these patients in clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others



Central nervous system


Cytochrome P450


US Food and Drug Administration






Non-steroidal anti-inflammatory drugs


Opioid receptor-like


Opioid use disorder


  1. Gudin J, Fudin J. A narrative pharmacological review of buprenorphine: a unique opioid for the treatment of chronic pain. Pain Ther. 2020;9(1):41–54.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Davis M, Pasternak G, Behm B. Treating chronic pain: an overview of clinical studies centered on the buprenorphine option. Drugs. 2018;78(12):1211–28.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Urman R, Jonan A, Kaye A. Buprenorphine formulations: clinical best practice strategies recommendations for perioperative management of patients undergoing surgical or interventional pain procedures. Pain Physician. 2018;21(1):E1–E12.

    Article  PubMed  Google Scholar 

  4. Warner N, Warner M, Cunningham J, Gazelka H, Hooten W, Kolla B, et al. A practical approach for the management of the mixed opioid agonist-antagonist buprenorphine during acute pain and surgery. Mayo Clin Proc. 2020;95(6):1253–67.

    Article  CAS  PubMed  Google Scholar 

  5. Dahan A, Yassen A, Romberg R, Sarton E, Teppema L, Olofsen E, et al. Buprenorphine induces ceiling in respiratory depression but not in analgesia. Br J Anaesth. 2006;96(5):627–32.

    Article  CAS  PubMed  Google Scholar 

  6. Watson PJQ, McQuay HJ, Bullingham RES, Allen MC, Moore RA. Single-dose comparison of buprenorphine 0.3 and 0.6 mg I.V. given after operation: clinical effects and plasma concentrations. Br J Anaesth. 1982;54(1):37–43.

    Article  CAS  PubMed  Google Scholar 

  7. Harcus AH, Ward AE, Smith DW. Buprenorphine in postoperative pain: results in 7500 patients. Anaesthesia. 1980;35(4):382–6.

    Article  CAS  PubMed  Google Scholar 

  8. Varrassi G, Marinangeli F, Ciccozzi A, Iovinelli G, Facchetti G, Ciccone A. Intra-articular buprenorphine after knee arthroscopy. Acta Anaesthesiol Scand. 1999;43(1):51–5.

    Article  CAS  PubMed  Google Scholar 

  9. Candido KD, Hennes J, Gonzalez S, Mikat-Stevens M, Pinzur M, Vasic V, et al. Buprenorphine enhances and prolongs the postoperative analgesic effect of bupivacaine in patients receiving infragluteal sciatic nerve block. Anesthesiology. 2010;113(6):1419–26.

    Article  CAS  PubMed  Google Scholar 

  10. Candido KD, Winnie AP, Ghaleb AH, Fattouh MW, Franco CD. Buprenorphine added to the local anesthetic for axillary brachial plexus block prolongs postoperative analgesia. Reg Anesth Pain Med. 2002;27(2):162–7.

    Article  CAS  PubMed  Google Scholar 

  11. Tigerstedt I, Tammisto T. Double-blind, multiple-dose comparison of buprenorphine and morphine in postoperative pain. Acta Anaesthesiol Scand. 1980;24(6):462–8.

    Article  CAS  PubMed  Google Scholar 

  12. Budd K. High dose buprenorphine for postoperative analgesia. Anaesthesia. 1981;36(9):900–3.

    Article  CAS  PubMed  Google Scholar 

  13. Lanz E, Simko G, Theiss D, Glocke MH. Epidural buprenorphine—a double-blind study of postoperative analgesia and side effects. Pain. 1985;22(2):211.

    Article  Google Scholar 

  14. Roberts DM, Meyer-Witting M. High-dose buprenorphine: perioperative precautions and management strategies. Anaesth Intensive Care. 2005;33(1):17–25.

    Article  CAS  PubMed  Google Scholar 

  15. Macintyre PE, Russell RA, Usher KA, Gaughwin M, Huxtable CA. Pain relief and opioid requirements in the first 24 hours after surgery in patients taking buprenorphine and methadone opioid substitution therapy. Anaesth Intensive Care. 2013;41(2):222–30.

    Article  CAS  PubMed  Google Scholar 

  16. Lembke A, Ottestad E, Schmiesing C. Patients maintained on buprenorphine for opioid use disorder should continue buprenorphine through the perioperative period. Pain Med. 2018;20(3):425–8.

    Article  PubMed Central  Google Scholar 

  17. Kohan L, Potru S, Barreveld AM, et al. Buprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel. Reg Anesth Pain Med. 2021;46(10):840–59.

    Article  PubMed  Google Scholar 

  18. Anderson TA, Quaye AN, Ward EN, Wilens TE, Hilliard PE, Brummett CM. To stop or not, that is the question. Anesthesiology. 2017;126(6):1180–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to William F. Barrett .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Barrett, W.F., Brewbaker, C. (2023). Buprenorphine, Buprenorphine/Naloxone (Suboxone). In: Li, J., Jiang, W., Vadivelu, N. (eds) First Aid Perioperative Ultrasound. Springer, Cham.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-21290-1

  • Online ISBN: 978-3-031-21291-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics