Isaac Marsolek MD Procedural sedation and Bupe How should patients be managed Difference for procedures with local anesthetic vs without local anesthetic Disclaimer Isaac Marsolek What is the issue ID: 1007354
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1. Procedural sedation for patients on buprenorphineIsaac Marsolek MD
2. Procedural sedation and BupeHow should patients be managed?Difference for procedures with local anesthetic vs without local anesthetic?
3. DisclaimerIsaac Marsolek
4. What is the issue?Buprenorphine blocks the mu opioid receptor. Potentially making analgesia more difficult to achieve. Patients and clinicians may have inaccurate beliefs about pain management on bupe leading to anxiety about procedures. Changing buprenorphine dosing can result in worse outcomes for patients.
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6. Evidence/LiteratureMostly perioperativeOne article from: Abdominal RadiologyRecommends not changing bupe dosing at all and starting with regular dosing of sedation medications and titrating up.Downer K, Burgan C, Kezar CE, Galgano SJ. Procedural moderate sedation in patients with opioid addiction and chronic pain: a practical primer for the radiologist. Abdom Radiol (NY). 2021 Aug 14. doi: 10.1007/s00261-021-03242-1. Epub ahead of print. PMID: 34390369.
7. Surgical flowsheetPain Medicine, 20(7), 2019, 1395–1408
8. HP GI Colonoscopy and upper endoscopy. All patients get screened for buprenorphine use (any product) and is referred to anesthesia services. No specific data on number of patients or outcomes.
9. *Please note buprenorphine comes in multiple different preparations. Butrans® and Belbuca® do not need dose adjustments and do not need to be stopped prior to procedural sedation