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

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 -opioid receptor binding limits the analgesic efficacy of full opioid agonists often necessitating multimodal approaches. 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. 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. 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.