Adapting Perioperative Pain Care for Opioid Use Disorder Patients

Use of medications for opioid use disorder (MOUD) among patients presenting for major surgery has risen steadily — a national insurance claims analysis of 8.1 million surgical admissions from 2016–2022 shows maintenance therapy is increasingly common.

The analysis of a national insurance claims database covering 8.1 million surgical admissions from 2016 to 2022 documented a clear upward trend in MOUD use among surgical patients, rising from 154.4 to 240.8 per 100,000 procedures over the study interval. About 80% of identified MOUD users were taking buprenorphine, which has different perioperative implications than methadone or naltrexone. The increase was heterogeneous across regions, sexes, and rural versus urban settings, indicating a shifting surgical case mix and new demands for perioperative assessment and planning.

Perioperative teams—especially anesthesiologists—are well placed to integrate addiction-treatment considerations into preoperative evaluation, intraoperative planning, and postoperative recovery pathways. The study highlights opportunities to update protocols, coordinate with addiction specialists, and expand education for surgical teams.

Clinically, teams must weigh continuation versus temporary modification of MOUD agents around the time of surgery. Continued buprenorphine maintenance was common and can offer safety advantages, while methadone and extended‑release formulations pose different perioperative considerations; agent-specific planning is required. Preventing withdrawal often involves maintaining daily dosing when feasible, providing short-acting opioid coverage if needed, and coordinating with outpatient addiction services for bridging. Prioritize multimodal, opioid‑sparing analgesia—regional anesthesia, acetaminophen, NSAIDs, ketamine, lidocaine infusions, and adjunct nonopioid agents—to optimize pain control and reduce opioid exposure while supporting recovery.