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Aguilar B, Penm J, Liu S, Patanwala AE. Efficacy and Safety of Transdermal Buprenorphine for Acute Postoperative Pain: A Systematic Review and Meta-analysis. THE JOURNAL OF PAIN 2023; 24:1905-1914. [PMID: 37442403 DOI: 10.1016/j.jpain.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/10/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023]
Abstract
Transdermal buprenorphine (TBUP) may have some advantages for the management of acute postoperative pain. The aim of this systematic review and meta-analysis was to investigate the efficacy and safety of TBUP compared to other analgesics or placebo for acute postoperative pain. A systematic search was conducted using Embase, MEDLINE, and Cochrane Central Register of Controlled Trials (CENTRAL) until December 26, 2022. The search included randomized controlled trials comparing TBUP versus other analgesics or placebo for acute postoperative pain. A certainty assessment was conducted using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. The protocol for this review was registered on Prospective Register of Systematic Reviews (CRD42022318601). In total, 15 studies involving 1,205 participants were included that compared TBUP versus fentanyl (n = 2), celecoxib (n = 3), placebo (n = 2), tramadol (n = 5), diclofenac (n = 3), parecoxib (n = 1), and flurbiprofen (n = 1). Meta-analyses were conducted for 3 comparators that involved 2 studies each. There was no significant difference in pain between TBUP 10 mcg/h versus fentanyl 25 mcg/h (standardized mean difference [SMD] -.03, 95% confidence interval [CI] -.86 to .81, P = .95, I2 = 85%). TBUP 10 mcg/h was associated with less pain compared to celecoxib 200 mg twice daily (SMD -.32, 95% CI -.58 to -.05, P = .02, I2 = 0%) and placebo (SMD -2.29, 95% CI -4.32 to -.27, P = .03, I2 = 94%). The GRADE assessment showed a very low certainty of evidence for all comparisons. There is insufficient evidence that TBUP improves pain control compared to other analgesics for acute postoperative pain. PERSPECTIVE: This systematic review and meta-analysis compared the use of TBUP to other analgesics for postoperative pain. The results showed that there is insufficient evidence to recommend the use of TBUP in this setting. The findings will help clinicians select the most appropriate opioid regimens for postoperative pain.
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Affiliation(s)
- Brydget Aguilar
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, New South Wales, Australia; Department of Pharmacy, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Shania Liu
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, New South Wales, Australia; Department of Pharmacy, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Asad E Patanwala
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, New South Wales, Australia; Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Albaqami MS, Alqarni AA, Alabeesy MS, Alotaibi AN, Alharbi HA, Alshammari MM, Aldhfery AH. Buprenorphine for acute post-surgical pain: A systematic review and meta-analysis. Saudi J Anaesth 2023; 17:65-71. [PMID: 37032687 PMCID: PMC10077784 DOI: 10.4103/sja.sja_822_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022] Open
Abstract
Our study was designed to evaluate the efficacy of buprenorphine for the management of acute post-surgical pain reported in published studies in the years 2015-2022. Comprehensive research was performed by using online resources like PUBMED and the Wiley Library database to gather the relevant literature. Two authors were assigned to independently collect the information. Cochran's Q-test and I square statistic were used to determine the heterogeneity across the studies. Publication bias was estimated by using the Egger regression analysis and found to be significantly present once the P value <0.05. In this review, 15 studies were included. The pooled ratio of pain reduction after 12 hours of surgery was reported as 11.2% with 97% heterogeneity. Day one shows 5.9 reductions in pain with 98% heterogeneity. The 3% more pain was reduced on day 2. The day 3 pooled pain reduction score was observed as 1.9%. The overall pool prevalence of pain reduction was noted as 6.2% at different time duration with significant heterogeneity of 100%. Buprenorphine transdermal and sublingual both have significant pain relief scores. The analgesic drug consumption was reduced at the end of the follow-up duration.
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Affiliation(s)
- Mohammed S Albaqami
- Department of Anesthesia, College of Medicine, Majmaah University, Al Majma'ah, 11952, Saudi Arabia
| | - Adel A Alqarni
- Department of Anesthesia, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Musab S Alabeesy
- College of Medicine, Majmaah University, Al Majma'ah, 11952, Saudi Arabia
| | - Ayidh N Alotaibi
- College of Medicine, Majmaah University, Al Majma'ah, 11952, Saudi Arabia
| | - Hazzaa A Alharbi
- College of Medicine, Majmaah University, Al Majma'ah, 11952, Saudi Arabia
| | | | - Ahmed H Aldhfery
- College of Medicine, Majmaah University, Al Majma'ah, 11952, Saudi Arabia
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Davies A, Murray J, Zalmay P, Ross E, Dar S, Wilson H. Transdermal Buprenorphine for Pain Management Following a Neck of Femur Fracture. Geriatr Orthop Surg Rehabil 2022; 13:21514593211070260. [PMID: 35070476 PMCID: PMC8777329 DOI: 10.1177/21514593211070260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/08/2021] [Accepted: 12/10/2021] [Indexed: 11/17/2022] Open
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.
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Affiliation(s)
- Andrew Davies
- Department of Bioengineering, Imperial College London, London, UK
| | - Jane Murray
- Department of Anaesthetics, Imperial College Healthcare NHS Trust, London, UK
| | - Pardis Zalmay
- Department of Geriatrics, Royal Surrey Hospital NHS Trust, Guildford, Surrey, UK
| | - Ewan Ross
- Department of Geriatrics, Royal Surrey Hospital NHS Trust, Guildford, Surrey, UK
| | - Shumaila Dar
- Department of Geriatrics, Royal Surrey Hospital NHS Trust, Guildford, Surrey, UK
| | - Helen Wilson
- Department of Geriatrics, Royal Surrey Hospital NHS Trust, Guildford, Surrey, UK
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Machado FC, Neto GC, Paiva LOD, Soares TC, Nakamura RK, Nascimento LDF, Campana CS, Lustosa LAMM, Cortez RA, Ashmawi HA. [Transdermal buprenorphine for acute postoperative pain: a systematic review]. Rev Bras Anestesiol 2020; 70:419-428. [PMID: 32819729 DOI: 10.1016/j.bjan.2020.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/24/2020] [Accepted: 04/04/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Postoperative pain is still a major concern in several surgical procedures. Multimodal analgesia is best for postoperative pain management; however, opioid therapy is still the main treatment for pain after surgical procedures. Transdermal buprenorphine is a partial μ agonist opioid widely used for chronic pain syndromes, with limited evidence for acute postoperative pain. A systematic review of studies examining transdermal buprenorphine for acute pain management after surgery was conducted. CONTENTS Data from PubMed, Embase, The Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL via EBSCOhost, and LILACS were reviewed, including randomized clinical trials that evaluated total postoperative pain, postoperative analgesic consumption, drug-related side effects and patient satisfaction with analgesia regimen. Data from nine studies (615 patients) were included in this review. Most studies initiated transdermal buprenorphine use 6 to 48 hours before surgery, maintaining use from 1 to 8 days after the procedure. Most studies showed lower or similar postoperative pain scores, postoperative analgesic consumption and patient satisfaction comparing buprenorphine to placebo, tramadol, celecoxib, flurbiprofen and parecoxib. The incidence of side effects varied between studies, with most showing no increase in drug-related side effects with buprenorphine use, except one study, which compared buprenorphine to oral tramadol, and one to transdermal fentanyl. However, most results were derived from evidence with an overall high or unclear risk of bias. CONCLUSIONS Although more studies are necessary, initial results show that transdermal buprenorphine seems to be an effective and safe opioid choice for management of acute postoperative pain.
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Affiliation(s)
- Felipe Chiodini Machado
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Departamento de Anestesiologia, São Paulo, SP, Brazil.
| | - Gilson Carone Neto
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Luisa Oliveira de Paiva
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Tamiris Cristina Soares
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Ricardo Kenithi Nakamura
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Leonardo de Freitas Nascimento
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Camila Sato Campana
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Lia Alves Martins Mota Lustosa
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Rachel Andrade Cortez
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Hazem Adel Ashmawi
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Departamento de Anestesiologia, São Paulo, SP, Brazil
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Machado FC, Neto GC, Paiva LOD, Soares TC, Nakamura RK, Nascimento LDF, Campana CS, Lustosa LAMM, Cortez RA, Ashmawi HA. Transdermal buprenorphine for acute postoperative pain: a systematic review. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 32819729 PMCID: PMC9373428 DOI: 10.1016/j.bjane.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Blanco-Antona F, González-Sarmiento R, García-Cenador B, Lozano FS. Transdermal Buprenorphine for Controlling Pain in Patients with Critical Lower-Limb Ischemia. PAIN MEDICINE 2020; 21:1083-1085. [PMID: 31313809 DOI: 10.1093/pm/pnz165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Francisco Blanco-Antona
- Department of Vascular Surgery, Clinical Hospital, University of Salamanca and Institute of Biomedical Research of Salamanca, Salamanca, Spain
| | - Rogelio González-Sarmiento
- Department of Vascular Surgery, Clinical Hospital, University of Salamanca and Institute of Biomedical Research of Salamanca, Salamanca, Spain
| | - Begoña García-Cenador
- Department of Vascular Surgery, Clinical Hospital, University of Salamanca and Institute of Biomedical Research of Salamanca, Salamanca, Spain
| | - Francisco S Lozano
- Department of Vascular Surgery, Clinical Hospital, University of Salamanca and Institute of Biomedical Research of Salamanca, Salamanca, Spain
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Xu C, Li M, Wang C, Li H, Liu H. Perioperative analgesia with a buprenorphine transdermal patch for hallux valgus surgery: a prospective, randomized, controlled study. J Pain Res 2018; 11:867-873. [PMID: 29731664 PMCID: PMC5927186 DOI: 10.2147/jpr.s153456] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Hallux 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 methods A 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. Results The 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. Conclusion The 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.
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Affiliation(s)
- Can Xu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Mingqing Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Chenggong Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Hui Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
| | - Hua Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China
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