Buprenorphine (Surgical — Analgesia)

How it works

It is a partial agonist at mu-opioid receptors with high receptor affinity, producing analgesia with a relative ceiling on respiratory depression.

Prescribing in practice

• Its high mu-receptor affinity can block or displace full opioid agonists, complicating titration of additional opioids for breakthrough or postoperative pain, and respiratory depression that does occur may respond poorly to standard naloxone reversal.
• Use with caution alongside other central nervous system depressants such as benzodiazepines, which increases sedation and respiratory risk.
• It can precipitate withdrawal in people physically dependent on full opioid agonists.

Monitoring

Monitor pain control, sedation, and respiratory rate, and review the analgesic plan carefully when other opioids are needed perioperatively.

Counselling the patient

• Tell your team if your pain is not controlled, as adjusting pain relief needs care with this medicine.
• It can make you drowsy, so do not drive until advised it is safe.
• Avoid alcohol and inform staff about all other medicines you take.

Evidence & guidelines

Buprenorphine is an established opioid analgesic whose partial agonist pharmacology and ceiling effect on respiratory depression are well characterised.