EP724 - Introduction of Buccal Buprenorphine in Enhanced Recovery Protocol for Colorectal Surgery Patients

Monday, May 11, 2026

8:27 AM - 8:32 AM ET

ePoster Presenter(s)

Corinne Praska, MD (she/her/hers)

General Surgery Resident
University of Wisconsin - Madison
University of Wisconsin - Madison
Madison, WI, United States

Disclosure information not submitted.

Author(s)

EC

Evie Carchman, MD, FACS

Associate Professor
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin, United States

Disclosure information not submitted.
GL

Glen E. Leverson, PhD

Biostatistician
University of Wisconsin School of Medicine and Public Health
Verona, Wisconsin, United States

Disclosure information not submitted.
Julia R. Berian, MD, MS (she/her/hers)

Assistant Professor
University of Wisconsin
University of Wiscosin - Madison
Madison, WI, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Ana De Roo, MD (she/her/hers)

Assistant Professor
University of Wisconsin-Madison
University of Wisconsin-Madison
Madison, WI, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
DH

Dana M. Hayden, MD, MPH

Professor
University of Wisconsin-Madison
Mazomanie, Wisconsin, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Charles P. Heise, MD, FACS, FASCRS

Professor of Surgery
University of Wisconsin, Madison
Madison, Wisconsin, United States

Disclosure information not submitted.
RK

Ray S. King, MD, PhD, FACS, FASCRS

Assistant Professor of Surgery
University of Wisconsin-Madison School of Medicine and Public Health
Madison, Wisconsin, United States

Disclosure information not submitted.
Elise H. Lawson, MD, MSHS (she/her/hers)

Associate Professor of Surgery
University of Wisconsin School of Medicine and Public Health
Madison, WI, US

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
CS

Cristina B. Sanger, MD

Associate Professor
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin, United States

Disclosure information not submitted.
BT

Beth E. Thompson, BS, RT(R)(CT)

Colorectal Database Manager
University of Wisconsin School of Medicine & Public Health, Madison, WI
Verona, Wisconsin, United States

Disclosure information not submitted.

Senior Author(s)

JS

John B. Silva, MD

Anesthesiologist (Acute Pain and Regional Anesthesia)
University of Wisconsin
Fitchburg, Wisconsin, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Julia R. Berian, MD, MS: This individual has no financial relationships with ineligible companies.

Ana De Roo, MD: This individual has no financial relationships with ineligible companies.

Dana M. Hayden, MD, MPH: This individual has no financial relationships with ineligible companies.

Elise H. Lawson, MD, MSHS: This individual has no financial relationships with ineligible companies.

Purpose/Background: Due to its advantages over full agonist opioids, we sought to add buccal buprenorphine to an existing enhanced recovery protocol and evaluate its impact on post-operative outcomes and opioid utilization. We developed a protocol for scheduled medication administration to opioid-naive patients undergoing inpatient, elective colorectal surgeries and performed a preliminary analysis, comparing patients who received buprenorphine to those who did not.

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Purpose/Background: Buprenorphine is a partial opioid agonist with high receptor affinity and long duration of action. These pharmacologic properties lead to sustained analgesia with reduced side effects compared to other full agonist mu-opioids. We sought to add scheduled buccal buprenorphine to our colorectal surgery enhanced recovery protocol (ERP) and evaluate its impact on length of stay, inpatient utilization of full agonist opioids, and rates of post-operative ileus.

Methods/Interventions: In 2024, we formed an inter-disciplinary team including Anesthesia (Acute Pain), Colorectal Surgery, and Pharmacy to develop a protocol for administration of buccal buprenorphine. Following institutional approval, we provided education to perioperative nursing staff and updated relevant order sets. Beginning in May 2025, opioid naïve patients undergoing inpatient, elective colorectal surgeries were prescribed scheduled buccal buprenorphine (one dose pre-operatively and every twelve hours post-operatively with strict criteria to hold the medication based on pain score, respiratory rate, and sedation score) until discharge. We then performed a preliminary analysis including patients who underwent loop ileostomy or colostomy takedown (takedowns); laparoscopic or robotic right hemicolectomy or ileocolic resection (rights); and laparoscopic or robotic low anterior resection, left hemicolectomy, or sigmoid colectomy (lefts). Patients were excluded from analysis for undergoing an open operation or receiving an epidural or patient-controlled analgesia pump post-operatively. Cases were matched 1:1 by index operation to controls that did not receive buprenorphine. All patients were part of our standardized institutional ERP with multimodal pain control including non-narcotic analgesia and transversus abdominis plane blocks. Length of stay (LOS), total daily morphine milligram equivalents (MME), daily MME of full opioid agonists (i.e. excluding buprenorphine), and rates of post-operative ileus were compared between groups using a two-sided unpaired t-test.

Results/Outcomes: A total of 50 patients were included in this study, 25 in the buprenorphine group and 25 controls. Six patients in each group were rights (6/25; 24%); seven were takedowns (7/25; 28%); and twelve were lefts (12/25; 48%). Barriers to buprenorphine administration and compliance with the updated ERP included lack of familiarity with buprenorphine, preventing administrations and maintaining scheduled dosing across phases of care. Average LOS in the buprenorphine group was 2.8 days (SD 1.1) compared to 3.1 days (1.4) in the control group (p=0.38). There was no significant difference in average LOS when stratified by type of index operation. Average total MME per hospital day was similar between groups (46.4mg [SD 21.6] buprenorphine vs. 43.1mg [ 24.9] controls; p=0.61), as was average full agonist MME (excluding buprenorphine) per hospital day (40.8mg [SD 21.7] buprenorphine vs. 43.1mg [24.9] controls; p=0.72). There were no adverse effects secondary to medication administration. One patient in each group developed a post-operative ileus (p=1).

Conclusion/Discussion: Preliminary analysis shows that the addition of scheduled buprenorphine to our colorectal surgery ERP did not significantly impact length of stay, total MME, full agonist MME, or rates of ileus. However, buccal buprenorphine did not cause any adverse events, was well-tolerated by patients, and warrants further investigation with ongoing analysis of a larger cohort of patients.