Managing Acute Surgical Pain in Patients on Buprenorphine: A Case-Based Learning Module

Background: Perioperative pain management in patients maintained on buprenorphine for opioid use disorder presents unique challenges, particularly in urgent surgical settings where proper planning and traditional opioid-based strategies may be ineffective. High-affinity partial μ-opioid receptor binding limits the analgesic efficacy of full opioid agonists often necessitating multimodal approaches. Case Description: This manuscript presents a fictional teaching case developed exclusively for educational purposes involving a 55-year-old patient maintained on buprenorphine-naloxone who requires emergency lower-extremity surgery following a traumatic injury. The case illustrates the use of regional anesthesia combined with ketamine, to achieve effective perioperative analgesia while continuing baseline buprenorphine therapy. Educational Value: The case is accompanied by teaching points and multiple-choice practice questions focused on the mechanisms of action of local anesthetics and ketamine, as well as perioperative considerations for buprenorphine management. This teaching case is designed to reflect a highly plausible real-world clinical scenario encountered in orthopedic trauma and perioperative pain management. Conclusion: This educational case highlights practical perioperative pain management strategies for patients receiving buprenorphine. This scenario does not represent a real patient encounter and is intended solely as a teaching tool for trainees and clinicians.