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Buprenorphine, Buprenorphine/Naloxone (Suboxone)

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First Aid Perioperative Ultrasound

Abstract

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.

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Abbreviations

CNS:

Central nervous system

CYP:

Cytochrome P450

FDA:

US Food and Drug Administration

HPA:

Hypothalamic-pituitary-adrenal

NMDA:

N-Methyl-D-aspartate

NSAIDs:

Non-steroidal anti-inflammatory drugs

ORL:

Opioid receptor-like

OUD:

Opioid use disorder

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Correspondence to William F. Barrett .

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Barrett, W.F., Brewbaker, C. (2023). Buprenorphine, Buprenorphine/Naloxone (Suboxone). In: Li, J., Jiang, W., Vadivelu, N. (eds) First Aid Perioperative Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-031-21291-8_15

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  • DOI: https://doi.org/10.1007/978-3-031-21291-8_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-21290-1

  • Online ISBN: 978-3-031-21291-8

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