Post-Operative Pain Control Following LVAD Placement in a Patient with Prior History of Opioid Use Disorder: A Case Report

For patients with an active or prior history of opioid use disorder (OUD), post-operative pain management following left ventricular assist device (LVAD) implantation can be challenging. It is imperative for an interdisciplinary team of specialists to collaborate to develop an individualized plan of care. Adopting multimodal analgesic strategies can minimize the risk of relapse and withdrawal. Here, we present a case of a multimodal analgesic plan using a bilateral parasternal perineural infusion and buprenorphine, a partial mu-opioid receptor agonist, for a patient who received an LVAD. Review of the total daily post-operative oral morphine equivalents (OME) trend revealed decreasing dependence on full mu-opioid receptor agonists as the dose of buprenorphine was increased. This illustrates that a primary buprenorphine strategy in conjunction with non-opioid analgesics can help manage post-LVAD pain in patients with OUD.