Quick Guide: Acute Pain and Perioperative Management in Opioid Use Disorder



The following applies to patients already on a medication for opioid use disorder. Patients who have opioid use disorder but are not on a medication should be managed according the accompanying guidelines “Inpatient Management of Opioid Use Disorder: Buprenorphine” and “Inpatient Management of Opioid Use Disorder: Methadone.”



Methadone: 

Before Surgery

 - Continue full dose

After Surgery

 - Continue full dose, consider splitting TID



Buprenorphine:

Before Surgery

 - Continue full dose 

 - Rarely, decrease to 12 mg 2-3 days prior to surgery

After Surgery

 - Continue full dose, consider splitting TID



Naltrexone:

Before Surgery

 - Hold oral for at least 72 hours

 - Hold IM for at least 30 days

After Surgery

 - Resume when no further need for opioids



Support for Hospital Opioid Use Treatment (SHOUT)



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