Perioperative Pain Management for Patients on Chronic Buprenorphine: A Case Report
Sy-Yeu S Chern, Rebecca Isserman, Linda Chen, Michael Ashburn and Renyu Liu*
Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Hospital of University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104 , USA
- *Corresponding Author:
- Renyu Liu, M.D., Ph.D
Department of Anesthesiology and Critical Care at the Hospital of the University of Pennsylvania
Perelman School of Medicine at the University of Pennsylvania
336 John Morgan Building, 3620 Hamilton Walk, Philadelphia PA, 19104, USA
E-mail: [email protected]
Received date: September 18, 2012; Accepted date: October 22, 2012; Published date: October 30, 2012
Citation: Chern SYS, Isserman R, Chen L, Ashburn M, Liu R (2012) Perioperative Pain Management for Patients on Chronic Buprenorphine: A Case Report. J Anesth Clin Res 3:250. doi: 10.4172/2155-6148.1000250
Copyright: © 2012 Chern SYS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Here we present a patient with a Type I Chiari malformation who was receiving buprenorphine for chronic pain who underwent two separate urogynecologic procedures for removal of vaginal mesh with two different pain management regimens. For the first procedure at an outside hospital, the patient’s usual dose of buprenorphine (8 mg sublingual every 8 hours) was continued up through her surgery and then a full opioid receptor agonist was used for postoperative pain management. The patient complained that this resulted in very poor pain control for her in the postoperative period. Prior to her second procedure, which was performed at our institution, buprenorphine was switched to a full opioid agonist (oral hydromorphone 4 mg every 4 to 6 hours, maximum 20 mg per day) for 5 days prior to surgery; postoperative pain was managed with full opioid receptor agonists. The patient again reported suboptimal pain control in spite of substantially increased doses of opioids. This case report highlights the difficulty of perioperative pain management for patients on chronic buprenorphine and emphasizes the need for additional investigation.