BACKGROUND Prescription rates for buprenorphine in opioid use disorder are increasing, and recent guidelines recommend its continuation during and after surgery; however, evidence from clinical outcome studies is limited. We tested the hypotheses that 1) perioperative continuation of buprenorphine does not result in higher pain scores and 2) that this approach does not result in higher supplemental postoperative opioid requirements. METHODS The Veterans Affairs Corporate Data Warehouse was queried for patients who underwent surgery while being prescribed buprenorphine/naloxone for opioid use disorder between 2010 and 2020. Analysis of the prescription record was used to infer buprenorphine management, and a 3:1 matched control set of patients without buprenorphine prescriptions was generated. We examined patients who continued buprenorphine, patients who had buprenorphine interrupted, and control patients. The primary outcome was time-weighted average postoperative pain scores from inpatient and outpatient sources within 72 hours of surgery. The secondary outcome was postoperative average daily morphine equivalent opioid requirements within two weeks of surgery. RESULTS A total of 1,881 surgical procedures in 1,673 patients taking buprenorphine for opioid use disorder were included; these procedures were matched to 5,748 control patients (5,775 procedures) without a buprenorphine prescription. Among the 1,881 procedures, 1,186 (63%) continued buprenorphine through the perioperative period while 695 (37%) interrupted buprenorphine. Pain scores were clinically similar for all three groups (4.1 ± 1.9 control [n = 3284], 4.9 ± 2.0 continued buprenorphine [n = 662], and 5.5 ± 1.7 interrupted buprenorphine [n = 419]; P < 0.001).Patients who continued buprenorphine did not require significantly more supplemental opioids as compared to controls (39.7 mg morphine equivalents/day ± 1.9 versus 36.5 ± 0.7, P = 0.23), and patients who interrupted buprenorphine received more supplemental opioids than those who continued it (74.2 ± 4.5 mg morphine equivalents/day versus 39.7 ± 1.9,respectively; P < 0.001). CONCLUSIONS Continuation of buprenorphine is not associated with higher average pain scores or postoperative opioid requirements, supporting recently published guidelines.

中文翻译：

---

接受手术的成年退伍军人继续使用丁丙诺啡/纳洛酮：在一项全国回顾性队列研究中检查术后疼痛和阿片类药物的使用。


背景 阿片类药物使用障碍患者丁丙诺啡的处方率正在增加，最近的指南建议在手术期间和手术后继续使用;然而，来自临床结局研究的证据是有限的。我们检验了以下假设：1） 围手术期继续使用丁丙诺啡不会导致更高的疼痛评分，以及 2） 这种方法不会导致更高的术后补充阿片类药物需求。方法 向退伍军人事务部企业数据仓库查询了 2010 年至 2020 年间接受手术同时因阿片类药物使用障碍而被开具丁丙诺啡/纳洛酮处方的患者。处方记录分析用于推断丁丙诺啡管理，并生成无丁丙诺啡处方患者的 3：1 匹配对照组。我们检查了继续使用丁丙诺啡的患者、中断丁丙诺啡的患者和对照患者。主要结局是手术后 72 小时内住院和门诊来源的时间加权平均术后疼痛评分。次要结局是术后两周内平均每日吗啡当量阿片类药物需求量。结果 共纳入 1,881 例服用丁丙诺啡治疗阿片类药物使用障碍的患者的 1,673 次外科手术;这些程序与没有丁丙诺啡处方的 5,748 名对照患者 （5,775 例） 相匹配。在 1,881 例手术中，1,186 例 （63%） 在围手术期继续使用丁丙诺啡，而 695 例 （37%） 中断丁丙诺啡。所有三组的疼痛评分临床相似 （对照组 4.1 ± 1.9 [n = 3284]，继续使用丁丙诺啡 4.9 ± 2.0 [n = 662]，中断丁丙诺啡 5.5 ± 1.7 [n = 419];P < 0.001）。与对照组相比，继续使用丁丙诺啡的患者不需要显着更多的补充阿片类药物（39.7 毫克吗啡当量/天± 1.9 对 36.5 ± 0.7，P = 0.23），中断丁丙诺啡的患者比继续使用丁丙诺啡的患者接受更多的补充阿片类药物（74.2 ± 4.5 毫克吗啡当量/天 vs 39.7 ± 1.9;P < 0.001）。结论 继续使用丁丙诺啡与较高的平均疼痛评分或术后阿片类药物需求无关，支持最近发布的指南。