Tpatient setting.Table three. Recommendations for Perioperative Management of Long-Acting Opioids and Medication Assisted Therapy (MAT).Medication Long-acting pure mu-opioid agonists for chronic pain (e.g., OxyContin), which includes continuous transdermal use (e.g., Duragesic) or intrathecal infusions Perioperative Strategy 1 Continue typical dose throughout periop period which includes on DOS, along with adequate intraop H-Ras Inhibitor Purity & Documentation analgesia Continue typical dose throughout periop period which includes on DOS, as well as sufficient intraop analgesia Alternative 1: Continue standard dose two throughout periop period such as on DOS, along with adequate intraop analgesia Choice 2 (take into account if high threat for relapse and/or quite painful process): Continue standard dose by way of day prior to surgery; temporarily boost and/or divide dosing into shorter intervals starting DOS, as well as enough intraop analgesia Continue typical dose all through periop period including on DOS, as well as sufficient intraop analgesia Postoperative Strategy 1 Continue standard dose and provide opioid-tolerant dosing for PRN opioid orders, think about PCA if expect considerable discomfort Continue common dose, may possibly divide into q6-8hr dosing to maximize analgesic advantage Supply opioid-tolerant dosing for PRN opioid orders Continue typical dose and supply opioid-tolerant dosing for PRN opioid orders Continue enhanced and/or divided buprenorphine regimen and use opioid-tolerant dosing for PRN opioid orders CYP3 Activator review Discharge on original/typical buprenorphine regimen with adequate opioid-tolerant PRN opioid supply Continue common dose and give opioid-tolerant dosing for PRN opioid ordersMethadoneBuprenorphine oral, sublingual, and buccal formulations (e.g., Suboxone, Subutex, Belbuca), which includes combination solutions with naloxoneBuprenorphine transdermal patch, subdermal implant, or subcutaneous implant (e.g., Butrans, Probuphine)Healthcare 2021, 9,9 ofTable three. Cont.Medication Naltrexone oral formulations (e.g., ReVia, Contrave) Naltrexone extended-release IM injection (e.g., Vivitrol)Perioperative Plan 1 Discontinue three days before surgery and hold on DOS, supply usual intraop analgesia Ideally schedule surgery for four weeks immediately after final injection and hold all through periop period, deliver usual intraop analgesiaPostoperative Strategy 1 Continue to hold therapy postop, give opioid-na e dosing for PRN opioid orders with close monitoring 3 Discontinue naltrexone at discharge and reinitiate with outpatient prescriber after discomfort recovery completeAll patients must get maximal multimodal pharmacologic and nonpharmacologic adjuncts across their care continuum as discussed in other sections, and all modifications to chronic therapies must be made in concert using the managing prescriber. two Some have advocated for preoperative dose reduction in sufferers on total day-to-day doses 126 mg; see discussion. three Sufferers on chronic naltrexone therapy may well exhibit increased sensitivity to opioids soon after naltrexone discontinuation due to opioid receptor up-regulation; increased monitoring for adverse events is warranted. Abbreviations: DOS = day of surgery, IM = intramuscular, intraop = intraoperative, periop = perioperative, PCA = patient-controlled analgesia, PRN = as needed. References: [18,116,117,11928].Standard belief has been to discontinue buprenorphine therapy prior to surgery to enable for unencumbered mu-opioid receptors and more efficient perioperative analgesia. Present information and clinical expertise have.