Buprenorphine: Mechanism and applications

Abstract Buprenorphine is a partial μ-opioid receptor agonist that is commonly used to treat chronic pain and opioid addiction as part of opioid maintenance therapy (OMT). Buprenorphine uniquely augments the clinician’s pharmacological arsenal through its partial agonism and long duration of action resulting in an increased safety profile. Unfortunately, clinical application of buprenorphine has been limited by misconceptions about its pharmacodynamic and pharmacokinetic characteristics and poses unique challenges for anesthesiologists. For example, due to its reputation for causing analgesic ceiling effects, many anesthesiologists are wary of continuing buprenorphine in the perioperative period; however, buprenorphine has been shown to be safe and effective in the perioperative setting and should be continued in most patients who are receiving OMT. In addition, buprenorphine offers an attractive option for chronic opioid therapy in suitable patients with chronic pain.