Management of Buprenorphine During Arterogram Procedures

Understanding Buprenorphine's Impact on Anesthesia

• The Society for Perioperative Assessment and Quality Improvement (SPAQI) recommends individualizing the approach based on the patient's daily dose, indication for treatment, and expected pain level 1
• Buprenorphine can be safely continued during procedures rather than discontinuing it, according to current evidence 3, 4

Recommendations for Arterogram Procedures

• Continue buprenorphine at the preoperative dose, particularly for patients being treated for opioid use disorder to prevent relapse risk 3, 5
• Inform the anesthesiologist about the patient's buprenorphine use to allow for appropriate anesthetic planning and dosing adjustments 2
• Anticipate that full mu-opioid agonists can still be effective when used alongside buprenorphine, though potentially at higher doses 2

Anesthetic Considerations

• Buprenorphine does not block the action of full mu-opioid agonists at clinically relevant doses, but rather can act synergistically 1
• Multiple drug interactions are possible, including potential QT-interval prolongation, so the anesthesiologist should be informed of all medications 1

Special Considerations

• Avoid discontinuing buprenorphine before procedures as it can lead to withdrawal, increased pain sensitivity, and risk of relapse in patients with opioid use disorder 3, 5
• For patients on a higher dose of buprenorphine (>12 mg daily), some practitioners may consider tapering to 12 mg daily over 2-3 days before elective procedures, though recent guidelines increasingly support maintaining the current dose 2

Common Pitfalls to Avoid

• Discontinuing buprenorphine unnecessarily can lead to withdrawal symptoms and increased relapse risk 3
• Assuming opioid analgesia won't work is incorrect, as full mu-opioid agonists can still provide effective analgesia in patients on buprenorphine 2
• Failing to communicate with the anesthesia team can lead to suboptimal sedation strategies, so the anesthesiologist needs to know about buprenorphine use 1