Comparative evaluation of analgesic efficacy of buprenorphine transdermal patch and fentanyl patch in management of postoperative pain after arthroscopic lower limb surgery

Abstract

Background and Aims: Transdermal opioids are newer modality in use for the control of postoperative pain, because of its noninvasiveness, longer duration of action, sustained blood levels, and with minimal side effects. The study was aimed to evaluate the efficacy of analgesia of buprenorphine patch 10, 20 μg·h -1 and fentanyl patch 25 μg·h -1 for relief of pain in the postoperative period in patients undergoing arthroscopic lower limb surgeries. Materials and Methods: It was a randomized, double-blinded, prospective study in which adult patients undergoing lower limb arthroscopic surgery were randomly segregated into three groups. In Group 1 (fentanyl patch 25 μg·h -1 ), Group 2 (buprenorphine patch 10 μg·h -1 ), and Group 3 (buprenorphine patch 20 μg·h -1 ), transdermal patches were applied 12 h prior to surgery. Mean NRS score, total rescue analgesic requirement, drug-related adverse effects, and hemodynamic status were evaluated till 72 h in the postoperative period. Results: Out of 175 screened patients, 150 patients were finally analyzed. Baseline characteristics were the same among all the three groups. Median NRS score was lowest in Group 3 [ P value < 0.05 at 2, 4, 8, 12, and 24 h after surgery (Kruskal Wallis test). The total consumption of postoperative rescue analgesic diclofenac was the lowest in Group 3 as compared to other groups without any significant increase in adverse events. Conclusions: In arthroscopic lower limb surgery, buprenorphine patch (20 μg·h -1 ) applied 12 h prior to surgery is an effective postoperative analgesic and it is not associated with any significant adverse effects.

Comparison between transdermal buprenorphine and intravenous paracetamol for post-operative analgesia after major plastic reconstructive surgery under general anesthesia – A randomized double-blind controlled trial

“…21 Khandelwal et al, very recently in 2021, evaluated the efficacy of analgesia of buprenorphine patch 10, 20 µg•h -1 and fentanyl patch 25 µg•h -1 for relief of pain in the postoperative period in patients undergoing arthroscopic lower limb surgeries and concluded that in arthroscopic lower limb surgery, buprenorphine patch (20 µg•h -1 ) applied 12 h before surgery is an effective post-operative analgesic and it is not associated with any significant adverse effects. 22 Niyogi et al, in 2017, evaluated the analgesic efficacy of buprenorphine patch for post-operative pain relief in patients undergoing spinal instrumentation surgery. They found that time to first post-operative rescue analgesic (tramadol) requirement was much delayed and also reduced in patients having TDB.…”

The Efficacy of Buprenorphine in Preoperative and Postoperative Patients: A Literature Review

“…Groups of the 175 patients were formed [17]. The postoperative pain was assessed using the numerical rating scale (NRS).…”

Transdermal opioids for acute postoperative pain: A road less travelled!

“…compared two doses of buprenorphine (10 μgh -1 and 20 μgh -1 ) with fentanyl (25 μgh -1 ) in adult patients undergoing lower limb arthroscopic surgery. [ 2 ] They found TDB patch (20 μgh -1 ) to be an effective postoperative analgesic without any significant undesirable effects.…”

“…Alternative analgesics should be started till the effect of TDS drugs comes in 12–24 h, whereas in the index study, the usual analgesics were withheld the day before surgery when the patches were applied. [ 2 ]…”

“…[ 5 ] Authors of present study evaluating the use of TDS in postoperative pain management concluded that further prospective randomized studies are required to conclusively find the optimum dose. [ 2 ]…”