Perioperative analgesia with a buprenorphine transdermal patch for hallux valgus surgery: a prospective, randomized, controlled study

Abstract

PurposeHallux valgus surgery often results in significant postoperative pain. Adequate control of pain is essential for patient satisfaction and improves the outcome of the procedure. This study aimed to investigate the perioperative analgesic effect of a buprenorphine transdermal patch in patients who underwent hallux valgus surgery.Patients and methodsA total of 90 patients were randomly divided into the following three groups based on the perioperative analgesic method: flurbiprofen axetil intravenous injection (Group F), oral celecoxib (Group C), and buprenorphine transdermal delivery system (BTDS) (Group BTDS). The pain status, degree of satisfaction, adverse effects, and administration of tramadol hydrochloride for uncontrolled pain were recorded on the night before surgery, postoperative day 1, postoperative day 2, and postoperative day 3.ResultsThe BTDS could effectively control perioperative pain for patients undergoing hallux valgus surgery. The analgesic effect of the BTDS was better than that of oral celecoxib. In addition, statistically significant differences were not observed in the visual analog scale (VAS) scores, adverse effects, and rescue analgesia between the patients who received the BTDS and the patients who received the flurbiprofen axetil intravenous injection. However, the degree of patient satisfaction of the BTDS group was significantly higher (P<0.05) than that of the other two groups.ConclusionThe BTDS (a preemptive analgesia regimen) could exert an analgesic effect during the perioperative period for patients who had received hallux valgus surgery, and this effect is beneficial for sustaining postoperative physiological and psychological states and promoting functional rehabilitation.

Transdermal buprenorphine for acute postoperative pain: a systematic review

“…As for postoperative pain medications, five studies showed lower rescue analgesic dosages in transdermal buprenorphine groups compared to placebo, 18 , 19 tramadol 16 and celecoxib. 23 Four studies showed no difference in additional analgesia usage with transdermal buprenorphine compared to transdermal fentanyl, 15 tramadol, 17 , 19 celecoxib 22 and flurbiprofen. 23 Two studies compared different doses of buprenorphine, in one the rescue analgesic consumption was higher in patients receiving 10 mcg h −1 than in patients receiving 20 mcg h −1 , 18 while in the other study rescue analgesic consumption decreased and transdermal buprenorphine dosage increased from 17.5 mcg h −1 to 32 mcg h −1 and 52.5 mcg h −1 .…”

“…Surgical procedures included spine surgery, 17 , 19 , 22 major 15 and elective 18 abdominal surgery, hysterectomy and myomectomy, 20 , 21 hip surgery, 16 and hallux valgus 23 corrections. Transdermal buprenorphine was started 6 to 48 hours before surgery in doses ranging from 5 mcg h −1 to 52.5 mcg h −1 15 , 16 , 17 , 18 , 22 , 23 and maintained for 1–7 days after the procedure. Only one study initiated transdermal buprenorphine 36 hours after surgery and maintained it for 28 days after the procedure.…”

“… 17 Control groups received placebo, 18 , 19 , 20 tramadol, 16 , 17 a different dosage of transdermal buprenorphine. 18 , 20 , 21 Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) 22 , 23 or transdermal fentanyl. 15 The risk of bias summary for included studies is shown in Fig.…”

“…In six studies, buprenorphine was considered more effective than placebo, 18 , 19 , 20 celecoxib 22 , 23 and tramadol 16 for reducing postoperative pain scores. In three studies, buprenorphine was considered as effective as tramadol, 17 parecoxib 22 and flurbiprofen 23 for reducing postoperative pain scores. In one study, buprenorphine led to higher VAS scores than transdermal fentanyl.…”

“… 5 , 6 , 9 Such a route has been used for the treatment of chronic pain conditions, 9 , 10 , 12 with some recent studies investigating the use of perioperative transdermal buprenorphine for the treatment of postoperative pain. 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 …”