Suboxone User Perioperative Early Referral and Enhanced Recovery After Surgery- Orthopaedic Trauma Surgery Population
Status:
Recruiting
Trial end date:
2020-11-30
Target enrollment:
Participant gender:
Summary
Suboxone treated patients present a unique challenge to providers during the perioperative
period in terms of pain control. If the patient is taken off their prescribed suboxone 48
hours prior to the procedure, the opioid pain medication will function but the patient is
exposed to the very medications originally responsible for their substance addiction. The
discontinuation of suboxone can potentially lead to opioid addiction relapse in this
situation (Anderson et al., 2017). If the patient remains on their suboxone, opioid pain
medications can be ineffective or require very large dosages to control pain but the
patient's risk of relapse may be lower (Anderson et al., 2017). Classic opioid pain
medications prescribed by providers for post-operative pain control such as hydromorphone,
morphine and fentanyl have lower affinity for the Mu 1 and 2 receptors when compared to
buprenorphine. These medications are less effective or ineffective when given to a patient
treated with Suboxone due to their inability to bind to the Mu receptor in the presence of
buprenorphine. The only clinically used full agonist opioid with stronger affinity for the MU
1 and 2 receptors is sufentanil. In theory, sufentanil would be able to displace
buprenorphine from the receptor and stimulate the receptor as a full agonist leading to
predictable pain control. Through the Kappa receptor antagonism, buprenorphine may improve
the treatment of opioid-induced hyperalgesia (Koppert W et al., 2005). Additional benefits
may include buprenorphine's Kappa receptor antagonism may help in treating forms of
depression and depression (Lalanne et al., 2014). At our institution, orthopedic trauma
patients have a high incidence of suboxone use and make an ideal study population as they are
often otherwise healthy. Our study compares opioid consumption in the perioperative period in
patients taking suboxone on presentation to the operating room. The patients will randomized
to receive conventional opioid based regimen versus buprenorphine and sufentanil based opioid
regimen. The goal of the study is to determine if the combination of buprenorphine and
sufentanil based pain control is superior to classic opioid treatment strategies in patients
taking suboxone while presenting for orthopedic trauma surgery.
Phase:
Phase 4
Details
Lead Sponsor:
West Virginia University
Collaborator:
West Virginia Clinical and Translational Science Institute