Femoral Fracture in Patient on Buprenorphine

You are the weekend on-call anaesthetist at a tertiary regional hospital. A 45-year-old man has been transferred to your emergency department for management of a femoral fracture after he fell last night. He received a femoral nerve block and splint at the referral hospital before being transferred to your facility. The surgeons are worried about increasing swelling and gross deformity of his thigh and would like to place a femoral nail as soon as possible. The patient has a past history of chronic back pain that was associated with OxyContin misuse. The OxyContin was converted to buprenorphine after a spinal fusion four months ago. He had breakfast six hours ago. Medications Buprenorphine 18 mg sublingual once daily Pantoprazole 40 mg once daily Observations Heart rate 100 beats per minute Blood pressure 110/85 mmHg SpO2 95% on room air Respiratory rate 16 breaths per minute Weight 160 kg Height 1.86 m Body mass index 45 kg/m2