For patients on buprenorphine maintenance, current perioperative guidance in many countries favours continuing it through surgery rather than stopping it, because stopping risks relapse and withdrawal and makes pain harder to manage. Analgesia is built around it: regional techniques, regular paracetamol and NSAIDs where safe, ketamine or other adjuncts, and full agonists titrated with monitoring if needed. The prescriber of the maintenance therapy should be told about the admission.
- Confirm the maintenance dose with the prescriber or pharmacy.
- Continue buprenorphine unless there is a specific reason not to.
- Plan regional and multimodal analgesia in advance.
- Arrange follow-up with the maintenance prescriber on discharge.
Why it matters
Stopping maintenance therapy for surgery risks relapse long after the wound has healed.
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