Buprenorphine Management in the Perioperative Period

Buprenorphine should not be routinely discontinued as adequate analgesia can be achieved (grade B, moderate level of certainty).


Discontinuing buprenorphine can increase the risk of OUD recurrence or harm (grade B, moderate level of evidence).


Current evidence suggests variation in recommendations with regard to tapering patients on high dose (>16 mg) of buprenorphine and in situations in which high levels of postoperative pain are anticipated; however, receptor availability studies and case reports suggest adequate analgesia can still be achieved even at high doses of buprenorphine. Thus, the working group recommends that, in addition to not routinely discontinuing buprenorphine prior to surgery, one should avoid tapering it perioperatively as well (grade B, moderate level of certainty).

Most available literature recommends the use of multimodal analgesia in the perioperative period in patients receiving buprenorphine for MOUD. Thus, the working group recommends that multimodal analgesia, including adjunctive medications and regional anesthesia techniques, should be used whenever possible (grade B, moderate level of certainty).


Additional evidence from opioid receptor binding studies and other literature review suggests that opioids can be administered in conjunction with buprenorphine to achieve adequate analgesia. Thus, it is the working group’s recommendation to consider administration of full mu agonists (with high affinity for the mu receptor) (grade B, moderate level of certainty) or increased and/or divided doses of buprenorphine (grade C, low level of certainty) with close monitoring for uncontrolled postoperative pain if multimodal analgesia proves inadequate.