# Intraoperative pain management for patients undergoing medication-assisted rehabilitation: a scoping review

## TL;DR

This review explores how to manage pain during surgery for patients on medication for opioid addiction, highlighting the need for more research and multimodal strategies.

## Contribution

The study maps existing literature and identifies a lack of research on intraoperative pain management for patients undergoing medication-assisted treatment for opioid use disorder.

## Key findings

- Only eight articles were found, showing limited evidence on intraoperative pain management for patients on opioid use disorder medications.
- Multimodal pain strategies and collaboration between nurse anaesthetists and anaesthesiologists are recommended for effective pain management in this patient group.

## Abstract

Managing pain relief during the intraoperative phase for patients receiving medication-assisted treatment for opioid use disorder is both challenging and complex. This patient group can have or develop increased opioid tolerance and heightened pain sensitivity. Both require a different approach to pain management compared with patients not receiving such treatment. This scoping review aimed to identify and map the literature on intraoperative pain management for patients receiving medication for opioid use disorder.

A systematic search of Embase (OVID), Medline and CINAHL, was undertaken in December 2023. All types of literature published from 2013 to 2023 were included, except for abstracts. A follow-up search was conducted in April 2025.

Eight articles were included: one qualitative study, one case study report, one expert Delphi study and five non-research articles. The results suggest a paucity of research on intraoperative pain management for patients undergoing medications for opioid use disorder.

Limited evidence exists regarding intraoperative pain management for patients undergoing medication-assisted treatment for opioid addiction. Despite this gap, existing literature discusses the roles of methadone, buprenorphine and naltrexone in the context of surgical treatment. Multimodal strategies can effectively manage pain for this complex group, and collaboration between nurse anaesthetists and anaesthesiologists is crucial for optimal pain management and patient safety.

The online version contains supplementary material available at 10.1186/s12871-025-03538-5.