Perioperative Management of Patients on Maintenance Medication for Addiction Treatment: The Development of an Institutional Guideline-Article

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The article discusses the development of an institutional perioperative pain management guideline for patients on maintenance medication for addiction treatment (MAT). The authors emphasize the importance of continuing opioid agonists like methadone and partial agonists like buprenorphine during the perioperative period, while discontinuing opioid antagonists like naltrexone. The authors provide an example of a standardized approach to perioperative management for patients on MAT in the form of a protocol. The article highlights the challenges of managing pain in patients with substance use disorder and the need to balance pain management with the risk of iatrogenic opioid use disorder. The authors recommend opioid-sparing approaches to pain management and screening for substance use disorder risk factors. They also discuss the use of non-opioid medications and regional anesthesia techniques in perioperative pain management. The article provides information on the pharmacology and perioperative considerations for methadone, buprenorphine, and naltrexone. It emphasizes the importance of individualized perioperative planning for patients on MAT, taking into account factors such as the type of surgery, opioid tolerance, and risk of recurrence of substance use. The authors highlight the need for further research and guidelines in this area and provide their protocol as a resource for other institutions.

Keywords

perioperative pain management

maintenance medication

MAT

opioid agonists

buprenorphine

opioid antagonists

iatrogenic opioid use disorder

non-opioid medications

regional anesthesia techniques

individualized perioperative planning