Purpose of the review <p>Our review discusses the pharmacologic profile of buprenorphine, then dives into the current literature regarding buprenorphine’s use to treat chronic pain, opioid use disorder, and acute postoperative pain. We aim to focus on how that literature may influence the perioperative management of patients on buprenorphine and prompt reconsideration of buprenorphine as a frontline opioid analgesic.</p> Recent findings <p> Buprenorphine has been used effectively for both acute and chronic pain management, for the treatment of opioid withdrawal, and for the treatment of opioid use disorder due to its unique pharmacological profile. Historically, there has been controversy over the best practice recommendations for buprenorphine use in the perioperative setting, though the data now overwhelmingly refutes the full discontinuation of buprenorphine preoperatively. It has also been seen in recent times that buprenorphine is at least as effective as usual care opioids for acute pain management, with important safety advantages.</p> Summary <p> Expanding our analgesic toolkit to more thoroughly understand the unique mechanism of action and properties of buprenorphine is paramount in our treatment of perioperative pain in both opioid-naïve and opioid-tolerant patients.</p>