June 2014
University of Colorado Hospital
Anesthesiology - Acute Pain Service
Pre-Operative Suboxone (buprenorphine) Protocol
Medication:
Suboxone PO (buprenorphine/naloxone)
(Note: naloxone is present as anti-tampering agent; it is inactive PO)
Typical Use:
Opioid Addiction/Dependence; Chronic Pain
Problem:
Resistance to Standard Opioid Medications; Uncontrollable Post-Op/Acute Pain
Patients taking Suboxone prior to surgery present a very challenging scenario. Buprenorphine is an
opioid partial agonist with a half-life of 24-60 hours. This medication blocks the effects of all standard
mu-opioid receptor analgesics. (e.g., fentanyl, morphine, hydromorphone, oxycodone, etc.). Patients
who present for surgery with current use of Suboxone are likely to have a poor experience postoperatively due to uncontrollable pain for multiple days. This increases the potential for morbidity as a
result of hypertension and tachycardia.
*RECOMMENDATION:
Discontinue Suboxone at least 5 days prior to procedure. *
Pre-operative
1. Alert patient the case will be cancelled if use is continued.
2. Patient should immediately contact prescribing physician.
3. Patient can be bridged with an oral opioid agonist by prescribing physician (e.g., oxycodone,
morphine, etc.).
Intra-Operative/Post-Operative
1. Opioids may be administered as usual, to effect. There is NO need to withhold opioids.
2. Multi-modal pain management (Regional/Neuraxial, Ketamine, NSAIDs, Acetaminophen)
Discharge
1. A course of oral opioids may be given, as needed, for post-surgical pain.
2. Patient should follow-up within one week with Suboxone prescribing physician and the
medication restarted when appropriate.
The Acute Pain Service may be contacted for questions or advice: pager 303-266-6493