Table 4.
| Minimal to No Pain | Moderate to Severe Pain | |
|---|---|---|
| University of Michigan Health System | Continue bup-nx and contact provider | Cancel surgery |
| Consider adding NSAIDS or acetaminophen | Coordinate with bup-nx provider to stop bup-nx ≥5 d, transition to shortacting opioids before surgery | |
| If off bup-nx ≥5 d, treat with regular opioids | If off bup-nx ≥5 d, use opioid analgesics for pain | |
| Consider adjuncts—acetaminophen, NSAIDs, gabapentin/pregabalin, alpha-2 agonist, low-dose ketamine infusion | ||
| Consider regional anesthesia | ||
| Return to bup-nx provider for reinduction | ||
| Boston Medical Center | Continue bup-nx and contact provider and consider | Hold bup-nx on the day of the surgery |
| Adding NSAIDs and acetaminophen | Give single-dose ER/LA before the surgery and continue ER/LA opioid to address baseline pain control | |
| Dividing bup-nx dose q6–8 h | Use PCA with no basal dose or IR/SA opioid analgesic for breakthrough pain | |
| Increasing bup-nx dose | Return to bup-nx provider within a week for consideration to reinduce bup-nx | |
| Adding short-acting opioid analgesics | ||
| University of Kentucky Health care | Continue bup-nx and contact provider | Continue bup-nx and contact provider |
| Consider adjuncts—acetaminophen/NSAIDs, opioids up to 3 d if necessary | Consider acute pain consult for potential PCA or regional modality | |
| Consider dividing bup-nx dose every 6–8 h | Admit in close observation unit to assess analgesia | |
| If off bup-nx, consider adjunct therapy with acetaminophen/NSAIDS or opioids | Continue opioid therapy for postoperative pain after discharge |
Abbreviations: bup-nx, buprenorphine–naloxone; ER/LA, extended release/long acting; NSAIDs, nonsteroidal anti-inflammatory drugs; PCA, patient-controlled analgesia.