Transdermal Buprenorphine-A Novel Medication for Postoperative Pain Management Following Abdominal Hysterectomy for Benign Gynecological Conditions

Abstract

Background: Buprenorphine is a semisynthetic derivative of thebaine, which is 75-100 times more potent than morphine and causes less respiratory depression. Efficacy and safety of transdermal buprenorphine have been well established in chronic pain, but data regarding acute postoperative pain relief are still limited. Aim: In this study, we compared the efficacy of transdermal buprenorphine patch with injectable tramadol for the relief of postoperative pain (POP) following abdominal hysterectomy for benign gynecological conditions. Settings and Design: Three-year prospective observational study. Methods and Material: One hundred patients undergoing abdominal hysterectomy were allocated to one of two groups. Buprenorphine group: we applied 10 mcg/hr transdermal buprenorphine patch on the lateral upper arm after surgery. The onset of relief from a patch is 8 to 16 hours. So, all patients were given diclofenac suppository 100mg before induction of anesthesia as a preemptive analgesic to reduce postoperative pain. Injectable Tramadol Group: Received intramuscular tramadol injections 50mg every 8 hours in the postoperative period. Patients were followed for two days to observe postoperative pain relief and adverse effects. If patients showed a Visual Analog pain (VAS) score >3, intravenous paracetamol was administered as a rescue analgesic. Results: POP was assessed at different time frames: 12, 24, 36 and 48 hours after hysterectomy. Mean pain score at rest in the buprenorphine group was significantly lower than that of the tramadol group. Patients experienced less pain on mobility in the buprenorphine group compared with the tramadol group, which was statistically significant. Conclusion: Transdermal buprenorphine is an effective and safe alternative to injectable tramadol for providing postoperative analgesia. It provides a higher degree of pain relief, faster postoperative mobilization, lower incidence of postoperative nausea and vomiting and higher satisfaction scores starting 12 hours after surgery. However, for the first 12 post-operative hours, there is a need for additional analgesia.