High dose buprenorphine for postoperative analgesia

Abstract

S-nrYBuprenorphine was given intravenously to produce analgesia in the immediate postoperative period, the dose being titratedagainst the response of each patient in order to obtain complete freedom from pain. In SO patients following lower segment Caesarean section under general anaesthesia, buprenorphine in the dose range 0.4-7.0 mg was found to be a potent, long lasting and safe analgesic. Serial blood gas estimations performed on ten of the patients confkmed the clinically observed lack of respiratory depression. Key wordsAnalgesic, narcotic; buprenorphine. Analgesia; postoperative. Anaesthesia; obstetric.The primary aim of postoperative analgesic medication is to provide relief from pain in every patient following surgery. The failure to achieve this is frequently due to the use of agents of inadequate analgesic potency, incorrect dosage and inappropriate route of administration. The intravenous route allows complete analgesia to be produced rapidly and the dose of the agent can be titrated against the response of the patient, thus eliminating the administration of too low or too high a dose and the occurrence of undesirable side-effects. This would be the optimal way in which to give analgesic drugs in the iminediate postoperative period. Buprenorphine, an oripavine derivative of thebane, is a recently introduced analgesic of the partial agonist-antagonist type. Its high potency and long duration of action together with a low incidence of side-effects indicate that it might be an ideal agent for use in the postoperative period. It was to investigate this concept that the study described here was initiated. MethodFifty female patients, of average age 27.5 years, were selected for study. They all underwent elective lower segment Caesarean section under general anaesthesia and were given buprenorphine in the immediate postoperative period to control their abdominal pain. All patients were given magnesium trisilicate 20 ml two hours before surgery and a second dose immediately before induction of anaesthesia. In addition, 18 patients received oral diazepam 20 mg and eighteen diazepam plus metoclopramide 10 mg two hours pre-operatively. Eacfi patient received a standard anaesthetic following a 4-minute period of preoxygenation. With a lateral Forum 90 1 tilt being maintained, anaesthesia was induced with thiopentone 250 mg, and cricoid pressure was applied by an assistant. Suxamethonium 100 mg was given to facilitate intubation of the trachea with a cuffed tube. Anaesthesia was maintained with oxygen (40%) and nitrous oxide (600/,), and muscular relaxation with incremental doses of pancuronium bromide. Syntocinon was given as necessary after delivery of the infant and at the termination of surgery residual neuromuscular blockade was reversed with a mixture of neostigmine (5.0 mg) and atropine (1.2 mg) in divided doses.When spontaneous ventilation had been re-established and a response to spoken command obtained, the patient was taken to the recovery room, where pulse rate, arterial blood pressure and respirator...

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Imaging Drugs with and without Clinical Analgesic Efficacy

“…(Patel and Lindley, 2003). BUP has FDA approval as an analgesic (Budd, 1981;Christoph et al, 2005;Cowan et al, 1977;Jasinski et al, 1978;Kogel et al, 2005), however, multiple clinical trials of NK 1 antagonists as analgesics have failed (Goldstein et al, 1997(Goldstein et al, , 2001Hill, 2000). Specifically, APREP failed to demonstrate significant analgesic effects in phase-II clinical trials.…”

Transdermal buprenorphine in clinical practice – a post‐marketing surveillance study in 13 179 patients

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