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

Authors Pergolizzi JV Jr, Magnusson P, LeQuang JA, Breve F, Mitchell K, Chopra M, Varrassi G

Received 12 January 2021

Accepted for publication 9 March 2021

Published 31 March 2021 Volume 2021:14 Pages 871—879


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Michael Schatman

Joseph V Pergolizzi Jr,1 Peter Magnusson,2,3 Jo Ann LeQuang,1 Frank Breve,4 Kailyn Mitchell,1 Maninder Chopra,5 Giustino Varrassi6

1NEMA Research, Inc., Naples, FL, USA; 2Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden; 3Department of Medicine, Cardiology Research Unit, Karolinska Institutet, Stockholm, Sweden; 4Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA, USA; 5Decision Alternatives, LLC, Frederick, MD, USA; 6Paolo Procacci Foundation, Rome, Italy

Correspondence: Jo Ann LeQuang
NEMA Research, Inc., 4005 Technology Drive, Suite 1008-V, Angleton, TX, 77515, USA
Tel +1-979-824-0251
Email [email protected]

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.

Keywords: acute pain control, ceiling effect of buprenorphine, geriatric pain patients, gynecological surgery, hip arthroscopy, knee arthroscopy, opioid-associated side effects, orthopedic rehabilitation, orthopedic surgery, postoperative pain, spinal surgery, transdermal buprenorphine dosing

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