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Perioperative Pain Management for Median Sternotomy in a Patient on Chronic Buprenorphine/Naloxone Maintenance Therapy: Avoiding Opioids in Patients at Risk for Relapse

Authors Alalade E, Bilinovic J, Walch AG, Burrier C, Mckee C, Tobias J

Received 11 July 2019

Accepted for publication 17 January 2020

Published 5 February 2020 Volume 2020:13 Pages 295—299


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 5

Editor who approved publication: Dr Michael Schatman

Emmanuel Alalade,1 Jena Bilinovic,1 Ana Gabriela Walch,1 Candice Burrier,1,2 Christopher Mckee,1,2 Joseph Tobias1,2

1Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA; 2Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA

Correspondence: Emmanuel Alalade
Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, Ohio 43205, USA
Tel +1 614 722-4200
Fax +1 614 722-4203

Abstract: The opioid crisis in the United States has been pandemic. As such, anesthesia providers are frequently faced with patients who have a history of opioid abuse or are currently receiving chronic therapy for such disorders. The chronic administration of medications such as buprenorphine-naloxone can impact the choice of perioperative anesthesia and pain control. Furthermore, the postoperative administration of opioids may lead to relapse in patients with a history of opioid abuse. We present a 26-year-old male with a history of opioid abuse on maintenance therapy with buprenorphine-naloxone, who presented for median sternotomy, cardiopulmonary bypass, and pulmonary valve replacement. The perioperative implications of buprenorphine-naloxone and implementation of multimodal analgesia are discussed, along with options to decrease or eliminate the perioperative use of opioids.

Keywords: buprenorphine/naloxone, cardiac surgery, opioid use disorder, opioid tolerant patients, addiction

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