Transdermal Buprenorphine for Pain Management Following a Neck of Femur Fracture

Abstract

Introduction Pain management in patients with hip fractures can be challenging. Poor pain control is associated with reduced mobility and increased morbidity. Inadequate analgesia in patients with dementia is a concern. After using several different alternatives, transdermal buprenorphine was chosen as a standardised approach for analgesia in patients with fragility fracture in our hospital. There is limited evidence on the use of buprenorphine in this population. Our aim was to investigate the safety and effectiveness of transdermal buprenorphine in patients with hip fractures. Methods A review of consecutive patients presenting with a hip fracture from June 2018 to December 2018 was conducted using medical records. Our primary outcome was the incidence of complications as a consequence of transdermal buprenorphine. Our secondary outcome was adequate analgesia measured by reviewing the requirement for analgesia during the first week following the patient’s admission. Analgesia demands were considered adequate if patients required less than 20 mg of oral morphine in total during the first week following injury. Results In total, 148 patients presented with a hip fracture during the study period. 128 patients had documented evidence of buprenorphine patch application. Complete data was available for the primary outcome of complications in all cases. Data was available for the secondary outcome in 124 patients. Buprenorphine was discontinued in 24 patients (19%), most commonly due to due to concerns about contribution to hypoactive delirium (9%), and when strong analgesia was no longer required (4%). There were no severe complications. Adequate analgesia was achieved using this regime in 68% patients. 38 patients (32%) required more than 20 mg of oral morphine sulphate solution in the first week post-admission. Conclusion This series suggests that transdermal buprenorphine is safe and effective in the management of pain following a neck of femur fragility fracture.

We Must Consider a Growing Opioid Epidemic in Older People

“…Whilst the opioid epidemic appears to garner an even greater public awareness, as geriatricians, we must act now to stem its potentially huge impact on that older population. Davies et al (2022) have considered strong opioid analgesia use in hospital, and despite their practice of buprenorphine patch removal on discharge (or at 2 weeks), they have not included information on analgesia requirements following discharge from hospital when the patch is removed. On a local level, we recognised the increasingly large number of older patients being prescribed opioids during their admission.…”

“…We instigated senior stewardship over prescribing, reviewing analgesics daily and aimed to avoid use of opioids at all on transfer from hospital to intermediate or community care. Whilst we welcome Davies et al (2022), it remains our responsibility as geriatric clinicians to do much more to evaluate and 'control' the appropriate and safe use of strong opioids in older people. We must support national bodies and agencies to stem the opioid epidemic that is now impacting this older population.…”

“…We are enthused to read Davies et al (2022) 1 recent series suggesting that transdermal buprenorphine is safe and effective in the management of pain following a neck of femur fragility fracture. Their paper brings to light an area of broader research which demands attention; the safe use of opioids in older people.…”