Regional anesthesia techniques stand as a potent strategy to mitigate or completely eradicate the need for opioid consumption in the perioperative setting, presenting significant benefits for patients with Opioid Use Disorder (OUD).
In the realm of neuraxial anesthesia, various adjuncts have proven their efficacy specifically for the OUD population. Sufentanil, for instance, although not directly opioid-sparing, has been shown to extend the duration of sensory and motor blockade in patients with OUD, contributing to prolonged pain relief. A notable example is a Randomized Control Trial where a combination of 5 mcg sufentanil and 3 mL of 0.5% hyperbaric bupivacaine was used for intrathecal block, showcasing the potential benefits of this approach.
Clonidine, another adjunct, has demonstrated advantages when included in epidurals, particularly for laboring OUD patients on buprenorphine therapy. An observational study highlighted the effectiveness of 1.2 mcg of clonidine in 0.1% bupivacaine or 2 mcg of clonidine in 0.0625% bupivacaine. Despite its benefits, practitioners should remain cognizant of potential side effects associated with clonidine, such as hypotension, sedation, and bradycardia, particularly at higher doses.
Dexmedetomidine has also emerged as a valuable adjunct, with documented reduction in patient-controlled analgesia use in the Post-Anesthesia Care Unit (PACU). A case study illustrated its efficacy when 1 mcg/mL dexmedetomidine was added to an epidural solution comprising 0.2% bupivacaine, hydromorphone 10 mcg/mL, and epinephrine 1:200,000, administered as a 5 mL bolus with a 20 mL/hr basal rate.
Turning to peripheral nerve blocks, sufentanil once again proves its merit, specifically in prolonging sensory and motor blockade during brachial plexus blocks for OUD patients. A Randomized Control Trial highlighted the effectiveness of a mixture of 10 mcg sufentanil and 30 mL 0.5% bupivacaine for this purpose.
In sum, the integration of regional anesthesia techniques, supplemented by carefully selected adjuncts, offers a powerful toolkit for reducing or eliminating opioid requirements in OUD patients. This approach not only addresses immediate postoperative pain but also aligns with broader goals of minimizing opioid exposure and dependence in this vulnerable population.
| Adjunct and setting | Reported regimen | Reported effect or caution |
|---|---|---|
| Sufentanil, intrathecal block | 5 mcg sufentanil with 3 mL of 0.5% hyperbaric bupivacaine | Not directly opioid-sparing, but extends the duration of sensory and motor blockade |
| Clonidine, epidural in the laboring patient on buprenorphine | 1.2 mcg clonidine in 0.1% bupivacaine, or 2 mcg clonidine in 0.0625% bupivacaine | Beneficial in this group; watch for hypotension, sedation, and bradycardia, particularly at higher doses |
| Dexmedetomidine, epidural | 1 mcg/mL added to 0.2% bupivacaine with hydromorphone 10 mcg/mL and epinephrine 1:200,000; 5 mL bolus with a 20 mL/hr basal rate | Documented reduction in patient-controlled analgesia use in the PACU |
| Sufentanil, brachial plexus block | 10 mcg sufentanil with 30 mL of 0.5% bupivacaine | Prolongs sensory and motor blockade |
