1406 - Perioperative buprenorphine for management of polyarticular arthritic pain in a patient with multiple joint replacements

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

CB

Chase Bauer, DO

resident
Jefferson Moss Magee
Philadelphia, Pennsylvania, United States

Co-Author(s)

LK

Leonard B. Kamen, DO

Attending
Jefferson Moss-Magee
Elkins Park, Pennsylvania, United States

Submitter(s)

CB

Chase Bauer, DO

Jefferson Moss Magee
Philadelphia, New Hampshire, United States

Case Diagnosis: Sublingual buprenorphine is indicated for induction and maintenance of patients with opioid use disorder. There is limited high-quality evidence regarding the use and management of buprenorphine for pain in the perioperative phase. Concerns for buprenorphine use in the perioperative p</span>eriod include the inability to achieve analgesia from full opioid agonists due to buprenorphine's high affinity and possible competition at the mu opioid receptor sites.(2) While there is evidence to support continuing buprenorphine for mild pain, for patients with moderate to severe pain, there is no clear consensus regarding the perioperative p</span>eriod (3).

Case Description: Ms. C is a 71-year-old female, with a history of rheumatoid arthritis and osteoporosis, who had undergone 11 hip replacements secondary to loosening and dislocation of the implanted prosthetics. Additionally, Ms. C underwent a left shoulder replacement in 2016 that required two revisions, the most recent in 2024. Over the course of her multiple surgeries Ms. C transitioned from high dose morphine and fentanyl products to SL buprenorphine to manage her polyarticular pain. Adequate analgesia was maintained on buprenorphine 8 mg up until two days prior to each of her last several surgeries. Oxycodone was re-initiated through the ensuing pre and post operative period for up to 7 days post operatively and she resumed her buprenorphine three days after surgery with no difficulty. Eventually we were able to reduce her dose of buprenorphine to 4 mg q 12 hours and to continue with prn tramadol with satisfactory pain control.

Discussions: This clinical vignette highlights that sublingual buprenorphine can be a viable analgesic medication when interspersed with a pure mu agonist opioid for perioperative pain in patients suffering from polyarticular arthritis following multiple joint replacement.

Conclusions: Buprenorphine is a viable analgesic option, with less respiratory risks than traditional opioids, perioperatively for maintenance of chronic polyarticular pain.