1
|
Sanfilippo F, Via LL, Zanghì A, Cappellani A. Efficacy of postoperative buprenorphine in the first 12 hours after surgery. Saudi J Anaesth 2024; 18:148-150. [PMID: 38313737 PMCID: PMC10833006 DOI: 10.4103/sja.sja_367_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 02/06/2024] Open
Affiliation(s)
- Filippo Sanfilippo
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- Department of Anesthesia and Intensive Care, “Policlinico-San Marco” University Hospital, Catania, Italy
| | - Luigi La Via
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- Department of Anesthesia and Intensive Care, “Policlinico-San Marco” University Hospital, Catania, Italy
| | - Antonio Zanghì
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Alessandro Cappellani
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| |
Collapse
|
2
|
Galosi M, Troisi A, Toniolo P, Pennasilico L, Cicirelli V, Palumbo Piccionello A, Di Bella C. Comparison of the Transdermal and Intravenous Administration of Buprenorphine in the Management of Intra- and Postoperative Pain in Dogs Undergoing a Unilateral Mastectomy. Animals (Basel) 2022; 12:ani12243468. [PMID: 36552388 PMCID: PMC9774767 DOI: 10.3390/ani12243468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/27/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
The aim of this prospective clinical study was to evaluate the effectiveness of transdermal patches of buprenorphine as an alternative route for the management of perioperative pain in dogs undergoing a unilateral mastectomy. Our hypothesis was that the transdermal route would allow the obtainment of an analgesic plan comparable to that of the injectable administration. Twelve dogs were divided in two groups. In the BupreP group (six dogs), buprenorphine patches were applied 40 h before the start of the surgery, guaranteeing a dosage of 5−6 μg/kg/h. In the BupreI group (six dogs), 20 μg/kg of buprenorphine was administered intravenously 30 min before the induction of anesthesia, and this was repeated every 6 h for 24 h. The main physiological parameters, sedation scores (0 = no sedation; 11 = deep sedation), and pain scores were monitored from 30 min before the surgery to 24 h after the end of anesthesia. All p values < 0.05 were defined as statistically significant. Thirty minutes before the surgery, the sedation scores were higher in BupreI (score = 10) compared to the BupreP group (score = 1). Moreover, during the mastectomy, the mean arterial pressure significantly increased in both groups even if nobody required additional analgesia. In the postoperative period, the pain scores did not show statistically significant differences between the two groups, maintaining values below the pain threshold at all times of the study. In conclusion, the transdermal administration of buprenorphine could guarantee an analgesic quality equal to that of the injectable route.
Collapse
Affiliation(s)
- Margherita Galosi
- School of Bioscience and Veterinary Medicine, University of Camerino, 62024 Matelica, Italy
| | - Alessandro Troisi
- School of Bioscience and Veterinary Medicine, University of Camerino, 62024 Matelica, Italy
| | - Pietro Toniolo
- School of Bioscience and Veterinary Medicine, University of Camerino, 62024 Matelica, Italy
| | - Luca Pennasilico
- School of Bioscience and Veterinary Medicine, University of Camerino, 62024 Matelica, Italy
| | - Vincenzo Cicirelli
- Department of Veterinary Medicine (DMV), University of Bari Aldo Moro, 70010 Valenzano, Italy
| | | | - Caterina Di Bella
- School of Bioscience and Veterinary Medicine, University of Camerino, 62024 Matelica, Italy
- Correspondence: ; Tel.: +39-0737-403460
| |
Collapse
|
3
|
Comparison of Efficacy and Safety of Transdermal Buprenorphine Patch and Conventional Analgesics in Intra-capsular Femur Neck Fracture Post Hemiarthroplasty. Indian J Orthop 2022; 56:1363-1369. [PMID: 35928664 PMCID: PMC9283632 DOI: 10.1007/s43465-022-00668-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND One of the most common fractures in the elderly population is a fracture of the neck of femur. Effective post-operative analgesia is a major challenge. Age-related co-morbidities restrict the choice of analgesics. The purpose of this study was to compare the efficacy and safety of transdermal buprenorphine [TDB] patch and conventional analgesics following hemiarthroplasty for intra-capsular fracture neck of femur. MATERIALS AND METHODS This was a prospective, randomized control study done in 60 patients undergoing hemiarthroplasty for intra-capsular fracture neck of femur over a period of 2 years. Patients were randomized in 2 groups. Group A received a combination of IV paracetamol and tramadol for first 48 h followed by oral formulation. In Group B patients, a transdermal buprenorphine patch of 5 mcg/h was applied at the beginning of surgery and was continued 2 weeks post-operative.Pain score by VAS was observed both at rest and on movement and followed up till 14 days post-operative. Primary target was to maintain a VAS ≤ 4. Rescue analgesic was given if the VAS was ≥ 6. Secondary targets were number of rescue analgesics required, adverse reactions and complications if any. RESULTS Group B had significantly lower pain scores at rest and during movement [p value 0.0012 to ≤ 0.0001], so was rescue analgesia requirement. No significant side effects were seen in TDB group. CONCLUSION TDB patch is safe and provides superior analgesia and compliance as compared to conventional analgesics in the post-operative period in proximal femur fracture surgeries.
Collapse
|
4
|
Duration of Clinical Benefit Produced by Intraoperative Ketamine Administration in Bariatric Surgery: More Research Is Warranted! : Letter to Editor on the Recently Published Article: Hung KC, Wu SC, Chang PC, Chen IW, Hsing CH, Lin CM, et al. Impact of Intraoperative Ketamine on Postoperative Analgesic Requirement Following Bariatric Surgery: a Meta-analysis of Randomized Controlled Trials. Obesity surgery. 2021 Oct 13. PubMed PMID: 34647233. Obes Surg 2022; 32:948-951. [PMID: 35067866 DOI: 10.1007/s11695-021-05831-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 11/16/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
|
5
|
Pergolizzi JV, Magnusson P, LeQuang JA, Breve F, Mitchell K, Chopra M, Varrassi G. Transdermal Buprenorphine for Acute Pain in the Clinical Setting: A Narrative Review. J Pain Res 2021; 14:871-879. [PMID: 33833565 PMCID: PMC8020131 DOI: 10.2147/jpr.s280572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/09/2021] [Indexed: 12/11/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Peter Magnusson
- Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden.,Department of Medicine, Cardiology Research Unit, Karolinska Institutet, Stockholm, Sweden
| | | | - Frank Breve
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA, USA
| | | | | | | |
Collapse
|
6
|
Nanda A, Sangineni KSD, Pakhare V, Ramchandran G. Comparative Evaluation of Efficacy of Preventive Analgesia with Diclofenac and Buprenorphine Patch versus Single Diclofenac Patch for Postoperative Pain following General Anesthesia for Laparoscopic Cholecystectomy. Anesth Essays Res 2021; 14:428-433. [PMID: 34092854 PMCID: PMC8159039 DOI: 10.4103/aer.aer_109_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/11/2021] [Accepted: 01/20/2021] [Indexed: 11/04/2022] Open
Abstract
Background Acute postoperative pain is managed with parenteral and oral medications requiring skilled personnel for administration and vigilance. Previous studies have been done either with transdermal buprenorphine or diclofenac patch separately in mitigating postoperative pain. Aims The primary aim was to compare pain scores and rescue analgesia requirement. The secondary aims were comparison of side effects, time to mobilization and oral intake start, sedation scores, and satisfaction scores of surgeons and patients receiving transdermal patches of buprenorphine and diclofenac versus placebo and diclofenac patches following laparoscopic cholecystectomy. Settings and Design This is a randomized double-blinded (1:1), case-control study. Materials and Methods One hundred patients undergoing laparoscopic cholecystectomies were enrolled for the study. Patients were allocated into two groups by computer-generated randomization: those receiving dual patch of buprenorphine and diclofenac (DP) and those receiving patches of diclofenac and placebo (SP). Outcomes were measured after extubation and at 4, 8, 12, 24, 36, and 48 h after surgery. Statistics Analysis was done using the Statistical Package for the Social Sciences version 22.0, R environment 3.2.2 for data analysis, and Microsoft Excel to generate graphs and tables. Results The pain scores and rescue analgesia requirements were significantly higher in group SP compared to group DP. Patient satisfaction scores were better with group DP. No significant difference was found in both the groups concerning sedation scores, side effects, and time to patient mobilization and start of oral intake. Conclusions Concomitant use of transdermal patches of buprenorphine and diclofenac for postoperative pain in laparoscopic cholecystectomy provides adequate analgesia and patient satisfaction without compromising postoperative recovery.
Collapse
Affiliation(s)
- Ananya Nanda
- Department of Anaesthesia, ESIC Medical College and Hospital, Hyderabad, Telangana, India
| | | | - Vandana Pakhare
- Department of Anaesthesia, ESIC Medical College and Hospital, Hyderabad, Telangana, India
| | - Gopinath Ramchandran
- Department of Anaesthesia, ESIC Medical College and Hospital, Hyderabad, Telangana, India
| |
Collapse
|
7
|
Xu X, Xie L, Liu H, Hu Y. Transdermal buprenorphine patch versus oral celecoxib for pain management after total knee arthroplasty: An open- label, randomized controlled trial. Orthop Traumatol Surg Res 2020; 106:915-919. [PMID: 32624377 DOI: 10.1016/j.otsr.2020.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study was performed to evaluate the analgesic efficacy and safety of transdermal buprenorphine (TDB) patched for post-operative pain control after total knee arthroplasty (TKA). The hypothesis was that patients receiving the TDB patch would have less pain in comparison to those treated with the oral COX-2 inhibitor celecoxib without increasing side effects. PATIENTS AND METHODS A total of 160 patients scheduled for primary TKA were randomly assigned to two groups: patients provided the TDB patch (10μg/h) (TDB group) and those provided oral celecoxib (CX group). The outcomes were pain scores measured using the visual analogue scale (VAS) during rest and activity, as well as morphine requirement, operated knee functional recovery and adverse events post-operatively. RESULTS The total morphine given during the first 72h post-operatively was significantly lower in the TDB group than CX group. The VAS scores were significantly lower in the TDB group than CX group during rest at 2, 4, 6, 12, 24 and 48h post-operatively, and during activity at 12, 24 and 48h and 3 days post-operatively. The mean range of motion on post-operative days (PD) 1, 2 and 3 were significantly greater in the TDB group. In addition, the Lysholm score was significantly higher in the TDB group on PD 3. There were no remarkable adverse events in either group. DISCUSSION Use of the TDB patch provides effective pain relief and reduces the requirement for rescue morphine without increasing side effects in comparison with oral celecoxib during the early post-operative stage following TKA. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Xinxian Xu
- The Osteopathy Department, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Linghui Xie
- The Radiology Department of Wenzhou Seventh Hospital, Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haixiao Liu
- The Osteopathy Department, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yuezheng Hu
- The Osteopathy Department, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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]
|
10
|
Li WM, Li FD, Xu H, Sun LC. Analgesic impact of buprenorphine transdermal patch in total hip arthroplasty: A randomized controlled trial protocol. Medicine (Baltimore) 2020; 99:e20405. [PMID: 32541462 PMCID: PMC7302595 DOI: 10.1097/md.0000000000020405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The efficacy and safety of buprenorphine transdermal patch (BTP) has been well established in chronic pain, but data regarding acute postoperative pain relief is still very limited. Therefore, we design a prospective, randomized, controlled study to evaluate the effectiveness and safety of the BTP for postoperative analgesia in total hip arthroplasty. METHODS This study is designed as a single-center, prospective, double-blind, randomized controlled trial. Group A receives a 10 mg patch of buprenorphine at the conclusion of surgery which is continued for 14 days. Group B receives a conventional analgesic regimen, that is, IV paracetamol 1 mg every 8 hours alternating with parenteral tramadol 50 mg every 8 hours for the first 2 postoperative days followed by oral administration of the same drug still the end of 2 weeks. A total of 160 patients are needed with an allowance for 10% drop-out. The primary outcome of this noninferiority study is opioid consumption within the first 24 hours following surgery. The secondary outcomes included numerical rating scale scores at rest, postoperative complications, length of hospital stay, and patient satisfaction. RESULTS This trial is expected to be the largest randomized trial assessing the efficacy of BTP after primary total hip arthroplasty and powered to detect a potential difference in the primary outcome. TRIAL REGISTRATION NUMBER This study protocol was registered in Research Registry (researchregistry5524).
Collapse
Affiliation(s)
- Wen-Min Li
- Department of Medicine, Linyi Cancer Hospital
| | - Feng-Dao Li
- Department of Orthopedics, Yinan County Hospital of Traditional Chinese Medicine
| | - Hua Xu
- Department of Orthopedics, Linyi Cancer Hospital, Shandong, China
| | - Li-Chen Sun
- Department of Medicine, Linyi Cancer Hospital
| |
Collapse
|
11
|
Londhe S, Patwardhan M, Shah R, Oak M. Efficacy and Safety of Buprenorphine Transdermal Patch for Immediate Postoperative Analgesia After Total Knee Arthroplasty Surgery. J Arthroplasty 2020; 35:S178-S181. [PMID: 32201109 DOI: 10.1016/j.arth.2020.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is associated with moderate-to-severe postoperative pain. Satisfactory perioperative analgesia is essential for a good and predictable surgical outcome. Effective postoperative pain control is a major challenge to the treating surgeon and his team. Old age and multiple comorbidities restrict the choice of analgesics one can offer. Transdermal buprenorphine (TDB), widely used in chronic pain management, has been rarely studied in acute postoperative setting. The purpose of this study was to compare the safety and efficacy of a TDB patch to conventional analgesics after knee arthroplasty surgery. METHODS A prospective randomized study was conducted with 200 patients aged 60-75 years undergoing TKA surgery under neuraxial anesthesia. All patients received periarticular local anesthetic infiltration and epidural/femoral nerve block infusion for 72 hours postoperatively. Group A received the TDB patch 5 mcg applied at the end of surgery. Group B received a combination of paracetamol and tramadol. All patients received intravenous diclofenac as rescue analgesia. Pain scores at rest, on movement, and side effects, if any, were compared over 7 days using the numerical rating scale score. RESULTS Pain scores at rest and on movement were significantly lower in group A (P values .008 and .01). Rescue analgesia requirement was also significantly less in this group. Only one patient had clinically significant respiratory depression, and 3 patients had local erythema. CONCLUSION Our data shows that the TDB patch is more efficacious in reducing postoperative pain after TKA surgery and can be safely used with fewer systemic side effects when compared to conventional analgesics.
Collapse
Affiliation(s)
- Sanjay Londhe
- CritiCare Multispecialty Hospital, Mumbai, Maharashtra, India
| | | | - Ravi Shah
- CritiCare Multispecialty Hospital, Mumbai, Maharashtra, India
| | - Mugdha Oak
- CritiCare Multispecialty Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
12
|
Niyogi S, Bhunia P, Nayak J, Santra S, Acharjee A, Chakraborty I. Efficacy of transdermal buprenorphine patch on post-operative pain relief after elective spinal instrumentation surgery. Indian J Anaesth 2017; 61:923-929. [PMID: 29217859 PMCID: PMC5703007 DOI: 10.4103/ija.ija_118_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIMS Transdermal buprenorphine patch (TDB) is increasingly used for chronic pain management because of non-invasive dosing, longer duration of action and minimal side effects. However its role in acute post-operative pain management for spinal instrumentation surgery is not well established. The aim of this study was to evaluate the analgesic efficacy of buprenorphine patch for postoperative pain relief in patients undergoing spinal instrumentation surgery. METHODS In this randomised, placebo-controlled, double-blinded, prospective study, 70 adult patients undergoing elective spinal instrumentation surgery were randomly allocated into two groups-TDB Group (buprenorphinepatch) and TDP Group (placebo patch). Time to first rescue analgesic requirement was the primary outcome. All patients also were monitored for total rescue analgesic requirement, drug-related adverse effect and haemodynamic status till 48 h after surgery. Statistical analysis was carried out using student independent t-test if normally distributed or with Mann-Whitney U-test if otherwise. RESULTS Time to first post-operative rescue analgesic (tramadol) requirement was much delayed in TDB Group than TDP Group (708.0 ± 6.98 min vs 54 ± 0.68 min, P < 0.001) and the total tramadol requirement was higher in TDB Group (490.60 ± 63.09 averagevs. 162.93 ± 63.91 mg, P < 0.001). Intra-and post-operative haemodynamic status was also stable in TDB Group without any adverse event. CONCLUSION A TDB patch (10 μg/hour) applied 24 hours before surgery can be used as a postoperative analgesic for lumber fixation surgery without any drug-related adverse effect.
Collapse
Affiliation(s)
- Saikat Niyogi
- Department of Anaesthesiology, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Pratibha Bhunia
- Department of Anaesthesiology, ESI Hospital, Kolkata, West Bengal, India
- Department of Anaesthesiology, N.R.S. Medical College, Kolkata, West Bengal, India
| | - Jisnu Nayak
- Department of Anaesthesiology, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
- Department of Anaesthesiology, Sagar Dutta Medical College, Kolkata, West Bengal, India
| | - Sankari Santra
- Department of Anaesthesiology, I.P.G.M.E.R, Kolkata, West Bengal, India
| | - Amita Acharjee
- Department of Anaesthesiology, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Indrani Chakraborty
- Department of Anaesthesiology, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| |
Collapse
|
13
|
Preemptive analgesia for postoperative hysterectomy pain control: systematic review and clinical practice guidelines. Am J Obstet Gynecol 2017; 217:303-313.e6. [PMID: 28351670 DOI: 10.1016/j.ajog.2017.03.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/07/2017] [Accepted: 03/13/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of the study was to investigate the effectiveness of preemptive analgesia at pain control in women undergoing total abdominal hysterectomy. DATA SOURCES Eligible studies, published through May 31, 2016, were retrieved through Medline, Cochrane Central Register for Controlled Trials, and Cochrane Database of Systematic Reviews. STUDY ELIGIBILITY We included randomized controlled trials with the primary outcome of pain control in women receiving a preemptive medication prior to total abdominal hysterectomy. Comparators were placebo, different doses of the same medication as intervention, or other nonnarcotic or narcotic medication. STUDY APPRAISAL AND SYNTHESIS METHODS Study data were extracted by one reviewer and confirmed by a second reviewer. For each outcome we graded the quality of the evidence. Studies were classified by the type of medication used and by outcome type. RESULTS Eighty-four trials met eligibility, with 69 included. Among nonnarcotic medications, paracetamol, gabapentin, and rofecoxib combined with gabapentin resulted in improvements in pain assessment compared with placebo and other nonnarcotic medications. Patient satisfaction was higher in patients who were given gabapentin combined with paracetamol compared with gabapentin alone. Use of preemptive paracetamol, gabapentin, bupivacaine, and phenothiazine resulted in less narcotic usage than placebo. All narcotics (ketamine, morphine, fentanyl) resulted in improved pain control compared with placebo. Narcotics had a greater reduction in pain assessment scores compared with nonnarcotics, and their use resulted in lower total narcotic usage. CONCLUSION Preemptive nonnarcotic and narcotic medications prior to abdominal hysterectomy decrease total narcotic requirements and improve patient postoperative pain assessment and satisfaction scores.
Collapse
|
14
|
Silverman S, Raffa RB, Cataldo MJ, Kwarcinski M, Ripa SR. Use of immediate-release opioids as supplemental analgesia during management of moderate-to-severe chronic pain with buprenorphine transdermal system. J Pain Res 2017; 10:1255-1263. [PMID: 28579823 PMCID: PMC5449099 DOI: 10.2147/jpr.s132595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background The buprenorphine transdermal system (BTDS) is approved in the US for the management of chronic pain. Due to its high affinity for μ-opioid receptors with a slow dissociation profile, buprenorphine may potentially displace or prevent the binding of competing μ-opioid-receptor agonists, including immediate-release (IR) opioids, in a dose-dependent manner. Health care professionals may assume that the use of IR opioids for supplemental analgesia during BTDS therapy is not acceptable. Materials and methods This post hoc analysis evaluated the use of IR opioids as supplemental analgesia during the management of moderate–severe chronic pain with BTDS at 52 US sites (BUP3015S, NCT01125917). Patients were categorized into IR-opioid and no-IR-opioid groups. At each visit of the extension phase, adverse events, concomitant medications, and information from the Brief Pain Inventory (BPI) were recorded. Results The most common supplemental IR opioids prescribed during BTDS treatment (n=354) were hydrocodone–acetaminophen and oxycodone–acetaminophen. The mean daily dose of IR opioids (morphine equivalents) for supplemental analgesia was 22 mg. At baseline, BPI – pain intensity and BPI – interference scores were higher for patients in the IR-opioid group. In both treatment groups, scores improved by week 4, and then were maintained throughout 6 months of the open-label extension trial. The incidence of treatment-emergent adverse events was similar in both groups. Conclusion Patients who were prescribed IR opioids reported lower scores for BPI pain intensity and pain interference to levels similar to patients receiving BTDS without IR opioids, without increasing the rate or severity of treatment-emergent adverse events. Patients prescribed concomitant use of IR opioids with BTDS had greater treatment persistence. The results of this post hoc analysis provide support for the concomitant use of IR opioids for supplemental analgesia during the management of moderate–severe chronic pain with BTDS.
Collapse
Affiliation(s)
- Sanford Silverman
- Comprehensive Pain Medicine, Pompano Beach.,Department of Integrated Medical Sciences, Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - Robert B Raffa
- Department of Pharmaceutical Sciences, School of Pharmacy, Temple University, Philadelphia, PA.,Department of Pharmacology and Toxicology, College of Pharmacy, University of Arizona, Tucson, AZ
| | | | | | | |
Collapse
|
15
|
Macintyre PE, Huxtable CA. Buprenorphine for the management of acute pain. Anaesth Intensive Care 2017; 45:143-146. [PMID: 28267934 DOI: 10.1177/0310057x1704500202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- P E Macintyre
- Director, Acute Pain Service, Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, Clinical Professor, Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia
| | - C A Huxtable
- Consultant Anaesthetist, Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, Adelaide, South Australia
| |
Collapse
|
16
|
Tang J, Fan J, Yao Y, Cai W, Yin G, Zhou W. Application of a buprenorphine transdermal patch for the perioperative analgesia in patients who underwent simple lumbar discectomy. Medicine (Baltimore) 2017; 96:e6844. [PMID: 28514299 PMCID: PMC5440136 DOI: 10.1097/md.0000000000006844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to investigate the perioperative analgesic effect of a buprenorphine transdermal patch in patients who underwent simple lumbar discectomy.In total, 96 patients were randomly divided into parecoxib intravenous injection (Group A), oral celecoxib (Group B), and buprenorphine transdermal patch groups (Group C). The pain status, degree of satisfaction, adverse effects, and condition in which the patient received tramadol hydrochloride for uncontrolled pain were recorded on the night before surgery, postoperative day 1, postoperative day 3, and postoperative day 5.The degree of patient satisfaction in Group C was higher than that in Groups A and B, with minimal adverse effects.The buprenorphine transdermal patch had a better perioperative analgesic effect in patients who underwent simple lumbar discectomy.
Collapse
|
17
|
Kumar S, Chaudhary AK, Singh PK, Verma R, Chandra G, Bhatia VK, Singh D, Bogra J. Transdermal Buprenorphine Patches for Postoperative Pain Control in Abdominal Surgery. J Clin Diagn Res 2016; 10:UC05-8. [PMID: 27504383 DOI: 10.7860/jcdr/2016/18152.7982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/24/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Buprenorphine is a semi-synthetic derivative of thebaine; its low concentration is sufficient to provide effective pain relief. AIM To evaluate the efficacy of transdermal buprenorphine patch in postoperative pain management. MATERIALS AND METHODS After ethical approval and taking informed consent from the patients, they were randomized into three groups (n=30 in each group) using a computer generated random number table. Group A: placebo patch; Group B: buprenorphine (10mg) patch and Group C: buprenorphine (20mg) patch. Haemodynamic and analgesic effects were compared by using analysis of variance (ANOVA) followed by Turkey's post hoc test. The proportion of side effects was compared using the Chi-square test. RESULTS Haemodynamic changes were not statistically different in all the three groups A, B and C, whereas at the end of surgery VAS score of Group A subjects was significantly higher (4.93±0.98) as compared to Group B (1.73±0.64) and Group C (1.40±0.50). On 2(nd) postoperative day, no pain was reported by the Group C patients and on 4(th) day after surgery, no pain was reported by Group B patients. CONCLUSION The transdermal buprenorphine patch (20mg) was effective in attenuating postoperative pain, maintaining haemodynamic stability requiring no rescue analgesia, with fewer postoperative rescue analgesic requirements in low dose of buprenorphine patch (10mg) group.
Collapse
Affiliation(s)
- Santosh Kumar
- Resident, Department of Anaesthesiology, King George's Medical University , U.P., Lucknow, India
| | - Ajay Kumar Chaudhary
- Associate Professor, Department of Anaesthesiology, King George's Medical University , U.P., Lucknow, India
| | - Prithvi Kumar Singh
- Ph.D. Scholar, Department of Anaesthesiology, King George's Medical University , U.P., Lucknow, India
| | - Reetu Verma
- Associate Professor, Department of Anaesthesiology, King George's Medical University , U.P., Lucknow, India
| | - Girish Chandra
- Professor, Department of Anaesthesiology, King George's Medical University , U.P., Lucknow, India
| | - Vinod Kumar Bhatia
- Professor, Department of Anaesthesiology, King George's Medical University , U.P., Lucknow, India
| | - Dinesh Singh
- Professor, Department of Anaesthesiology, King George's Medical University , U.P., Lucknow, India
| | - Jaishri Bogra
- Professor, Department of Anaesthesiology, King George's Medical University , U.P., Lucknow, India
| |
Collapse
|