Table 3.

Perioperative Pain Management of Patients With OUD on Bunrenornhine–Naloxone

	Preoperative Planning	Inpatient Management	Discharge Planning
Patients with OUD on bup-nx	Contact bup-nx provider	Continue bup-nx if minimal to no pain is expected	Coordinate with bup-nx provider for follow-up
	Involve patient, provider, and support person for decisions regarding bup-nx and pain management	Consider adjuncts—NSAIDs, acetaminophen, dividing bup-nx dose 3–4 times a day	Clear instructions for pain medications and follow-up
	Consider APS/SUD consult	Continue bup-nx for moderate to severe pain	Consider OPENP
		Consult APS for PCA
		Consider regional anesthesia
		Close nursing monitoring
		Maximize adjuncts—dexmedetomidine, acetaminophen around the clock, gabapentin/pregabalin
		If bup-nx has been discontinued, consider SUD consult
		Consider methadone or ER/LA opioids for OUD to avoid withdrawal and cravings

Abbreviations: APS, acute pain service; bup-nx, buprenorphine–naloxone; ER/LA, extended release/long acting; NSAIDs, nonsteroidal anti-inflammatory drugs; OPENP overdose prevention education and naloxone prescription; OUD, opioid use disorder; PCA, patient-controlled analgesia; SUD, substance use disorder.