Efficacy and adverse effects of buprenorphine in acute pain management: systematic review and meta-analysis of randomised controlled trials

White, Leigh; Hodge, Anthony; Vlok, Ruan; Hurtado, Glenn; Eastern, K; Melhuish, Thomas

doi:10.1016/j.bja.2017.11.086

Cited by 68 publications

(48 citation statements)

References 35 publications

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“…Finally, given that these were small studies, it is unlikely that they were adequately powered to detect significant differences in adverse effect. The adverse effect rate is in keeping with larger adult based meta-analyses, and therefore, larger studies are unlikely to add to the results seen in this meta-analysis [ 15 , 16 ].…”

Section: Discussionsupporting

confidence: 56%

Buprenorphine versus Morphine in Paediatric Acute Pain: A Systematic Review and Meta-Analysis

Murray

Malla

Vlok

et al. 2018

Critical Care Research and Practice

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Introduction In lab-based studies, buprenorphine appears to have a ceiling effect on respiratory depression but not on analgesia. There is increasing evidence in adult patients that buprenorphine has no ceiling effect on analgesia or side effects. The aim of this study was to investigate the efficacy and adverse effects of buprenorphine versus morphine in paediatric acute pain. Methods A systematic review of five databases was performed until May 2018. Only randomised controlled trials were eligible for inclusion. The outcomes of interest included pain, respiratory depression, nausea, sedation, dizziness, and pruritus. Results Four randomised controlled trials (n=195) were included. The only outcome measuring analgesic efficacy was time to breakthrough analgesia. Buprenorphine had a significant increase in time to breakthrough analgesia by 114.98 minutes compared to morphine (95% CI = 42.94 to 187.01; I2 = 0; p=0.002). There was no significant difference in the rates of adverse effects. Conclusions Buprenorphine provided a longer duration of analgesia than morphine. This in combination with its unique sublingual preparation could prove particularly advantageous in the paediatric population. The studies included are likely underpowered to detect differences in the incidence of adverse effects; therefore, the same precautions should be taken as with any other opioid.

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Section: Discussionsupporting

confidence: 56%

Buprenorphine versus Morphine in Paediatric Acute Pain: A Systematic Review and Meta-Analysis

Murray

Malla

Vlok

et al. 2018

Critical Care Research and Practice

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“…Individuals using buprenorphine to prevent relapse and suffering from opioid cravings will experience the agonistic effects including decreased craving, sedation, miosis, and mild respiratory depression [10]. In contrast to other opioids, buprenorphine demonstrates a 'ceiling effect' on respiratory depression and euphoria, though not on analgesia [11,12].…”

Section: Mechanism Of Actionmentioning

confidence: 99%

Approach to buprenorphine use for opioid withdrawal treatment in the emergency setting

Cisewski

Santos

Koyfman

et al. 2019

The American Journal of Emergency Medicine

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Opioid use disorder (OUD) is increasing in prevalence throughout the world, with approximately three million individuals in the United States affected. Buprenorphine is a medication designed, researched, and effectively used to assist in OUD recovery. Objective: This narrative review discusses an approach to initiating buprenorphine in the emergency department (ED) for opioid-abuse recovery. Discussion: Buprenorphine is a partial mu-opioid receptor agonist with high affinity and low intrinsic activity. Buprenorphine's long half-life, high potency, and 'ceiling effect' for both euphoric sensation and adverse effects make it an optimal treatment alternative for patients presenting to the ED with opioid withdrawal. While most commonly provided as a sublingual film or tablet, buprenorphine can also be delivered via transbuccal, transdermal, subdermal (implant), subcutaneous, and parenteral routes. Prior to ED administration, caution is recommended to avoid precipitation of buprenorphine-induced opioid withdrawal. Following the evaluation of common opioid withdrawal symptoms, a step-by-step approach to buprenorphine can by utilized to reach a sustained withdrawal relief. A multimodal medication-assisted treatment (MAT) plan involving pharmacologic treatment, as well as counseling and behavioral therapy, is essential to maintaining opioid remission. Patients may be safely discharged with safe-use counseling, close outpatient follow-up, and return precautions for continued management of their OUD. Establishing a buprenorphine program in the ED involves a multifactorial approach to establish a pro-buprenorphine culture. Conclusions: Buprenorphine is an evidence-based, safe, effective treatment option for OUD in an ED-setting. Though successfully utilized by many ED-based treatment programs, the stigma of 'replacing one opioid with another' remains a barrier. Evidence-based discussions on the safety and benefits of buprenorphine are essential to promoting a culture of acceptance and optimizing ED OUD treatment.

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“…6 In an effort to reduce post-operative pain and the repercussions associated with it, research is currently focused on refining local anaesthetic (LA) regimens, in preference to an increased reliance on systemic opioids. 1,[6][7][8][9][10] knee arthroscopy, there are currently no systematic reviews or meta-analyses on the topic. The primary aim of this systematic review and meta-analysis was to investigate whether or not tramadol, when used as an adjunct to IA LA infiltration, improves postoperative pain scores when compared with alternative regimens.…”

Section: Introductionmentioning

confidence: 99%

Tramadol as an adjunct to intra‐articular local anaesthetic infiltration in knee arthroscopy: a systematic review and meta‐analysis

Ryan

Hodge

Holyoak

et al. 2019

ANZ Journal of Surgery

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Background Arthroscopic knee surgery is a common technique used in Australia. Post‐operative pain is common and can lead to delayed discharge and impair early mobilization. Use of local anaesthesia can reduce pain while avoiding systemic side effects. This systematic review and meta‐analysis aimed to establish the use of tramadol as an adjunct to intra‐articular local anaesthetic infiltration in knee arthroscopy in the current literature. Methods Two independent reviewers performed a systematic search of four databases, where 24 articles were identified with six studies (four high‐quality and two low‐quality randomized controlled trials), with a total of 334 patients were included for analysis. RevMan 5.3 software (The Nordic Cochrane Centre, Copenhagen, Denmark) was used to perform the data analysis. The studies included focused on outcomes such as pain scores, breakthrough analgesia, total analgesia, time to discharge and adverse events related to the use of tramadol as an adjunctive therapy. Results This study found that using tramadol as an adjunct to intra‐articular local anaesthetic infiltration in arthroscopic knee surgery reduced post‐operative pain and increased time to breakthrough analgesia without an increase in side effects. Conclusion This meta‐analysis suggests that tramadol is an efficacious adjunct for use in intra‐articular local anaesthetic infiltration following arthroscopic knee surgery.

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Efficacy and adverse effects of buprenorphine in acute pain management: systematic review and meta-analysis of randomised controlled trials

Cited by 68 publications

References 35 publications

Buprenorphine versus Morphine in Paediatric Acute Pain: A Systematic Review and Meta-Analysis

Buprenorphine versus Morphine in Paediatric Acute Pain: A Systematic Review and Meta-Analysis

Approach to buprenorphine use for opioid withdrawal treatment in the emergency setting

Tramadol as an adjunct to intra‐articular local anaesthetic infiltration in knee arthroscopy: a systematic review and meta‐analysis

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