Transdermal buprenorphine for acute postoperative pain: a systematic review

Machado, Felipe Chiodini; Neto, Gilson Carone; Paiva, Luísa Oliveira de; Soares, Tamiris Cristina; Nakamura, Ricardo Kenithi; Nascimento, Leonardo de Freitas; Campana, Camila Sato; Lustosa, Lia Alves Martins Mota; Cortez, Rachel Andrade; Ashmawi, Hazem Adel

doi:10.1016/j.bjane.2020.06.009

Cited by 5 publications

(5 citation statements)

References 30 publications

(108 reference statements)

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“…The key finding of this study was that the use of TBUP in the postoperative critically ill patient did not improve pain control compared with non-TBUP treatment modalities. Although a previous systematic review has identified nine previous clinical trials investigating TBUP for postoperative pain, none focused on the critically ill patient population ( 5 ). The studies were also small without sample size calculations and with sample sizes ranging from 45 to 96 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Buprenorphine is available in a transdermal formulation, which is indicated for chronic pain. However, there is interest in the use of transdermal buprenorphine (TBUP) for acute postoperative pain, especially when there is an expectation for severe and sustained pain after major surgical procedures ( 5 , 6 ). Although there is a sublingual formulation of buprenorphine available for break through pain, the rationale for use of TBUP is to provide a stable background level of analgesia.…”

mentioning

confidence: 99%

“…However, in one national position statement, an exception is considered with wording acknowledging that sustained-release opioids may be useful for prolonged pain states on an individualized and temporary basis in the postoperative or posttraumatic setting ( 7 ). In a systematic review that included nine clinicals, the use of TBUP for acute postoperative pain was associated with improved pain control in six trials and decreased opioid consumption in five trials ( 5 ). The studies were small, were heterogeneous, and had a high or unclear risk for bias.…”

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confidence: 99%

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Effectiveness of Transdermal Buprenorphine for Pain Control in the ICU After Major Surgical Procedures

Patanwala

Moran

Johnstone

et al. 2022

Critical Care Explorations

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OBJECTIVES: Transdermal buprenorphine (TBUP) may be useful for postoperative pain after major surgery, when pain is expected to be severe and sustained. The objective of this study was to compare pain control and opioid consumption in critically ill postoperative patients who were treated with TBUP or not during ICU admission. DESIGN: This was a retrospective, parallel, cohort study. SETTING: ICU of a quaternary, urban hospital in Sydney, Australia. PATIENTS: Data were obtained for all patients admitted to the ICU from January 2019 to July 2021 after major gastrointestinal (GI) or genitourinary (GU) surgery. INTERVENTIONS: TBUP or non-TBUP. MEASUREMENTS AND MAIN RESULTS: Pain control was compared between patients who received TBUP and those who did not receive TBUP. The primary outcome was the probability of significant pain. A significant pain score was defined as greater than or equal to 4 on the 0–10 numeric rating scale or greater than or equal to 6 on the behavioral pain scale. Inverse probability of treatment weighting was used to adjust for baseline differences. The cohort included 376 patients, with 224 (60%) in the control group and 152 (40%) in the TBUP group. The mean age was 60 ± 14 years, 202 (54%) were male, mean Acute Physiology and Chronic Health Evaluation III score was 44 ± 13, and 147 (39%) received mechanical ventilation. After adjustment, the median probability of significant pain was 0.25 with control and 0.30 with TBUP (median difference, 0.02; 95% CI, 0.04–0.11; p = 0.44). The median opioid consumption (oral morphine milligram equivalents) per day was 5.7 mg with control and 10.1 mg with TBUP (median difference, 0.4 mg; 95% CI, –0.4 to 3.7 mg; p = 0.31). CONCLUSIONS: In patients who are admitted to the ICU after major GI or GU procedures, the use of TBUP in the ICU was not associated with improved pain control or opioid consumption compared with those who did not receive TBUP.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Effectiveness of Transdermal Buprenorphine for Pain Control in the ICU After Major Surgical Procedures

Patanwala

Moran

Johnstone

et al. 2022

Critical Care Explorations

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“…Furthermore, its extended duration of action stems from its gradual dissociation from the opioid receptor. 30 …”

Section: Discussionmentioning

confidence: 99%

Concomitant use of pre-emptive analgesia with local and general anesthesia in rat uterine pain surgical model

Mumtaz,

Baseer,

Habib

2024

Mol Pain

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Preemptive analgesia is used for postoperative pain management, providing pain relief with few adverse effects. In this study, the effect of a preemptive regime on rat behavior and c-fos expression in the spinal cord of the uterine surgical pain model was evaluated. Method: It was a lab-based experimental study in which sixty female Sprague-Dawley rats; eight to ten weeks old, weighing 150–300 gm were used. The rats were divided into three main groups: i) Control group (CG), ii) superficial pain group (SG) (with skin incision only), iii) deep pain group (with skin and uterine incisions). Each group was further divided into three subgroups based on the type of preemptive analgesia administered i.e., “tramadol, buprenorphine, and saline subgroups.” Pain behavior was evaluated using the “Rat Grimace Scale” (RGS) at 2, 4, 6, 9 and 24 hours post-surgery. Additionally, c-fos immunohistochemistry was performed on sections from the spinal dorsal horn (T12-L2), and its expression was evaluated using optical density and mean cell count two hours postoperatively. Results: Significant reduction in the RGS was noted in both the superficial and deep pain groups within the tramadol and buprenorphine subgroups when compared to the saline subgroup (p≤0.05). There was a significant decrease in c-fos expression both in terms of number of c-fos positive cells and the optical density across the superficial laminae and lamina X of the spinal dorsal horn in both SD and DG (p≤0.05). In contrast, the saline group exhibited c-fos expression primarily in laminae I-II and III-IV for both superficial and deep pain groups and lamina X in the deep pain group only (p≤0.05). Conclusion: A preemptive regimen results in significant suppression of both superficial and deep components of pain transmission. These findings provide compelling evidence of the analgesic efficacy of preemptive treatment in alleviating pain response associated with uterine surgery.

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“…The incidence of side effects varied among studies, but most studies showed that transdermal buprenorphine reduced postoperative pain, was associated with less postoperative consumption of oral analgesics, and resulted in higher patient satisfaction than placebo or comparator (tramadol, celecoxib, flurbiprofen, acetaminophen). 21 Gynecological Surgery In a study of 45 women undergoing open gynecological surgery, patients were randomized to receive different doses of the transdermal buprenorphine patch (17.5 μg/h, 35 μg/h or 52.5 μg/h) with rescue morphine and intravenous ketorolac available. 22 An inverse association was found between the transdermal patch dose and the use of morphine (p=0.04), ketorolac (p=0.04) or both (p=0.02).…”

Section: Postoperative Acute Painmentioning

confidence: 99%

Transdermal Buprenorphine for Acute Pain in the Clinical Setting: A Narrative Review

Pergolizzi¹,

Magnusson²,

LeQuang³

et al. 2021

JPR

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Transdermal buprenorphine is indicated for chronic pain management, but as its role in the clinical management of acute pain is less clear, this narrative review examines studies of the patch for acute pain, mainly in the postoperative setting. Although perhaps better known for its role in opioid rehabilitation programs, buprenorphine is also an effective analgesic that is a Schedule III controlled substance. Although buprenorphine is a partial agonist at the μ-opioid receptor, it is erroneous to think of the agent as a partial analgesic; it has full analgesic efficacy and unique attributes among opioids, such as a ceiling for respiratory depression and low "drug likeability" among those who take opioids for recreational purposes. Transdermal buprenorphine has been most thoroughly studied for acute pain control in postoperative patients. Postoperative pain follows a distinct and predictable trajectory depending on the type of surgery and patient characteristics. Overall, when the patch is applied prior to surgery and left in place for the prescribed seven days, it was associated with reduced postoperative pain, lower consumption of other analgesics, and patient satisfaction. Transdermal buprenorphine has been evaluated in clinical studies of patients undergoing gynecological surgery, hip fracture surgery, knee or hip arthroscopy/ arthroplasty, shoulder surgery, and spinal surgery. Transdermal buprenorphine may also be appropriate pain medication for controlling pain during postsurgical orthopedic rehabilitation programs. Transdermal buprenorphine may result in typical opioid-associated side effects but with less frequency than other opioids. Despite clinical reservations about transdermal buprenorphine and its potential role in acute pain management in the clinical setting, clinical acceptance may be hampered by the fact that it is off-label and buprenorphine is better known as an opioid maintenance agent rather than an analgesic.

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Transdermal buprenorphine for acute postoperative pain: a systematic review

Cited by 5 publications

References 30 publications

Effectiveness of Transdermal Buprenorphine for Pain Control in the ICU After Major Surgical Procedures

Effectiveness of Transdermal Buprenorphine for Pain Control in the ICU After Major Surgical Procedures

Concomitant use of pre-emptive analgesia with local and general anesthesia in rat uterine pain surgical model

Transdermal Buprenorphine for Acute Pain in the Clinical Setting: A Narrative Review

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