title: New Pain Management Options for the Surgical Patient on Methadone and Buprenorphine.
abstract: Perioperative management of patients receiving opioid addiction therapy presents a unique challenge for the anesthesiologist. The goal of pain management in this patient population is to effectively manage postoperative pain, to improve patient satisfaction and outcomes, and to reduce the cost of health care. Multimodal analgesics, including nonsteroid anti-inflammatory drugs, intravenous acetaminophen, gabapentanoid agents, and low-dose ketamine infusions, have been used to improve postoperative pain and to reduce postoperative opioid use. Patients on long-term opioid management therapy with methadone and buprenorphine require special considerations. Recommendations and options for treating postoperative pain in patients on methadone and buprenorphine are outlined below. Other postoperative pain management options include patient-controlled analgesia, intravenous, and transdermal, in addition to neuraxial and regional anesthesia techniques. Special patient populations include the parturient on long-term opioid therapy. Recommendations for use of opioids in these patients during labor and delivery and in the postpartum period are discussed.
authors.affiliation: Department of Anesthesiology, LSUHSC Shreveport, Shreveport, LA, USA.
authors.forename: Sudipta
authors.initials: S
authors.lastname: Sen
authors.affiliation: Department of Anesthesiology, LSUHSC Shreveport, Shreveport, LA, USA.
authors.forename: Sailesh
authors.initials: S
authors.lastname: Arulkumar
authors.affiliation: Department of Anesthesiology, LSUHSC Shreveport, Shreveport, LA, USA.
authors.forename: Elyse M
authors.initials: EM
authors.lastname: Cornett
authors.affiliation: Department of Anesthesiology, LSUHSC New Orleans, New Orleans, LA, USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Gayle
authors.affiliation: Department of Anesthesiology, LSUHSC New Orleans, New Orleans, LA, USA.
authors.forename: Ronda R
authors.initials: RR
authors.lastname: Flower
authors.affiliation: Department of Anesthesiology, LSUHSC Shreveport, Shreveport, LA, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Fox
authors.affiliation: Department of Anesthesiology, LSUHSC New Orleans, New Orleans, LA, USA. alankaye44@hotmail.com.|Department of Anesthesiology, Louisiana State University Health Science Center, 1542 Tulane Ave., New Orleans, LA, 70112, USA. alankaye44@hotmail.com.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Kaye
mesh_terms: D002047:Buprenorphine / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008691:Methadone / Q000627:therapeutic use*; D009357:Neonatal Abstinence Syndrome / Q000517:prevention & control; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D049590:Postpartum Period; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome
chemical_list: D002047:Buprenorphine; D008691:Methadone
keywords: Analgesia; Buprenorphine; Drug abuse; Methadone; Opiates; Pain; Patient-controlled analgesia; Pregnancy