Dr Muhammad Husaini Saleh

Moderator: Dr Mohd Fitry bin Zainal Abidin

20 Sept 2024

1. A multidisciplinary approach (surgery, anesthesia, regional teams) in collaboration with the patient’s primary prescriber
   and/or addiction psychiatrist is recommended to guide the perioperative pain management of opioid tolerant patients.
2. Multimodal analgesic techniques including both pharmacologic and nonpharmacologic modalities and regional/neuraxial
   anesthesia should be employed when possible throughout the perioperative period.
3. Opioids prescribed for chronic pain should be continued throughout the perioperative period (especially long-acting
   opioids), including the morning of surgery.
4. For patients treated with medications for opioid use disorder, buprenorphine (with or without naloxone) and methadone
   should generally be continued throughout the perioperative period, while naltrexone (intramuscular or oral) should be
   held preoperatively.
5. Patients should be given detailed discharge instructions and close postoperative follow up with the primary
   provider/prescriber is essential.

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