Buprenorphine Transdermal Patch Research Articles

Evaluation of physical variables, thermal nociceptive threshold testing and pharmacokinetics during placement of transdermal buprenorphine matrix-type patch in healthy adult horses.

Matrix type transdermal buprenorphine patches have not been investigated in horses and may provide an effective means of providing continuous pain control for extended period and eliminating venous catheterization. Assessment of the physiological variables (heart rate, respiratory rate, body temperature) and thermal nociceptive threshold testing, and describing the pharmacokinetic profile of transdermal buprenorphine matrix-type patch (20 μg h-1 and 40 μg h-1 dosing) in healthy adult horses. Randomised experimental study with a Latin-square design. Six adult healthy horses received each of the three treatments with a minimum 10 day washout period. BUP0 horses did not receive a patch (control). BUP20 horses received one patch (20 μg h-1) applied on the ventral aspect of the tail base resulting in a dose of 0.03-0.04 μg kg-1 h-1. BUP40 horses received two patches placed alongside each other (40 μg h-1) on the tail base resulting in a dose of 0.07-0.09 μg kg-1 h-1. Whole blood samples (for determination of buprenorphine concentration), physiological variables and thermal threshold testing were performed before (0 h) and at 2, 4, 8, 12, 16, 24, 32, 40, 48, 56, 64, 72, and 96 h after patch application. The patches were removed 72 h following placement and were analyzed for residual buprenorphine content. Between the three groups, there was no change in physiological variables across timepoints as compared to baseline (p > 0.1). With the higher dose, there was a significant increase in thermal thresholds from baseline values from 2 h until 48 h and these values were significantly higher than the group receiving the lower patch dose for multiple timepoints up to 40 h. 40 μg h-1 patch led to consistent measurable plasma concentrations starting at 2 h up to 96 h, with the mean plasma concentrations of > 0.1 ng/ml from 4 h to 40 h. 20 μg h-1 and 40 μg h-1 patch doses were well tolerated by all horses. At higher dose, plasma buprenorphine concentrations were more consistently measurable and blunted thermal thresholds for 48 h vs. 32 h with 20 μg h-1 dosing as compared to control.

Buprenorphine microdosing regimen using transdermal buprenorphine patches to transition from methadone to buprenorphine.

This case series records a cohort of patients treated with transdermal buprenorphine patches as part of a buprenorphine microdose induction protocol to transition from methadone to buprenorphine in a community setting. This has historically been a difficult process to manage in community settings and this case series explored a method to gradually manage this in an outpatient setting. A retrospective file audit was conducted of the electronic medical records of cohealth Innerspace patients who had undergone buprenorphine microdose induction using transdermal patches. A total of 32 patients were identified. In this case series 23 of the 32 patients successfully transitioned from methadone to sublingual or long-acting injectable depot buprenorphine preparations utilising the transdermal buprenorphine microdosing technique. All patients in this case series regardless of the success of the transition were retained in treatment. A fixed-dose transdermal buprenorphine patch regimen enabled 23 of 32 patients in this case series transition from methadone to buprenorphine in an outpatient setting. Given the small sample size further research is required to demonstrate the effectiveness of this technique.

Analgesic effect and safety of a half-dose transdermal buprenorphine patch after arthroscopic rotator cuff repair

ObjectiveTo retrospectively explore the effect of a half-dose buprenorphine transdermal patch for analgesia after arthroscopic rotator cuff repair (ARCR). MethodsThis analysis was performed with clinical data from patients who received unilateral ARCR in our hospital between October 2017 and December 2020. The patients were divided into three groups (30 cases each). In group A (control group), 100 mg flurbiprofen axetil (FA) was administered twice a day for 5 days after surgery. In group B (experimental group), 100 mg FA was administered twice a day for 5 days and half (2.5 mg) of a buprenorphine transdermal patch was applied after surgery; an additional half (2.5 mg) patch was applied 3 days later. In group C (condition control group), 100 mg FA was administered twice a day for 5 days and a 5-mg patch was applied directly after surgery. The visual analog scale (VAS) was administered repeatedly 1 day before surgery and 1, 2, 3, 5, and 14 days after surgery in each group. The simple shoulder test (SST) score, range of shoulder forward elevation (FE), and external rotation (ER) were recorded preoperatively and 12 weeks postoperatively. ResultsVAS scores on postoperative days 3 and 5 were significantly lower in groups B and C than in group A (p < 0.05). The VAS score on postoperative day 14 was significantly lower in group C than in group A (p < 0.05). The difference in VAS score between groups B and C was not significant (p > 0.05). All patients had significantly improved VAS scores, SST scores, FE, and ER at 12 weeks postoperatively. ConclusionThe half-dose buprenorphine transdermal patch had a good analgesic effect with minimal side effects after ARCR and did not delay the recovery of shoulder joint function.

Treatment characteristics of chronic low back pain patients treated with buprenorphine buccal film or transdermal patch.

Aims: Retrospective insurance claims analysis exploring treatment characteristics in chronic low back pain patients prescribed buprenorphine buccal film (Belbuca®) or transdermal patches. Patients and methods: The first buprenorphine prescription (buccal film or transdermal patch) was an index event. Patients were observed over 6month pre- and post-index periods. Propensity score matching minimized the selection bias. Results: Buccal film patients had a higher buprenorphine daily dose (501.7 vs 270.9 µg; p <0.001). The patch-to-film switching rate was higher than vice versa (11.5 vs 3.8%; p <0.001). The buccal film showed a greater reduction in opioid prescriptions (-1.1 vs -0.7; p =0.012), daily morphine milligram equivalents (-12.6 vs -7.3; p <0.001) and opioid treatment duration (-13.4 vs -7.6days; p =0.022). Conclusion: Buccal film was associated with higher buprenorphine doses and a greater reduction of opioid burden.

Comparative study of the efficacy of fentanyl and buprenorphine transdermal patch for post-operative analgesia in lower-limb orthopedic surgery

Background: Opioids are frequently employed as part of a comprehensive perioperative pain management strategy. Among the various routes of administering analgesics, transdermal drug delivery systems offer advantages over oral and parenteral methods. Transdermal opioid patches represent a contemporary approach to managing post-operative pain due to their non-invasiveness, prolonged efficacy, and reduced reported side effects. Aims and Objectives: This study aimed to assess the effectiveness of post-operative pain reduction using buprenorphine and fentanyl patches in patients undergoing surgeries for lower limbs in the department of orthopedics. Materials and Methods: This comparative and cross-sectional study included 80 adult patients undergone lower-limb surgeries for orthopedic conditions. They are randomly divided into two groups. In Group B (n = 40), buprenorphine patches at 10 μg/h were applied, while in Group F (n = 40), fentanyl patches at 25 μg/h were applied 12 h before surgery. Mean visual analog scale (VAS) scores, sedation scores, total rescue analgesic requirements, and any perceived or reported adverse effects were assessed over a 72-h post-operative period. Results: The age, body weight, and duration of surgeries between the two groups were similar. The VAS scores indicated lower pain levels in the group receiving fentanyl patch compared to the group of patients receiving buprenorphine patch. The total consumption of the analgesic injection was lower in the group receiving the fentanyl patch. Sedation scores and adverse effects were more prevalent in patients receiving buprenorphine patches compared to the group receiving fentanyl patches. Conclusion: For pain management in patients undergoing lower-limb surgeries, the fentanyl transdermal patch demonstrates greater effectiveness compared to the transdermal buprenorphine patch. Hence, doctors may think using it for their patients for better pain management and well-being of the patients.

Reliability of urine drug testing among patients on buprenorphine transdermal patch.

Urine drug testing (UDT) plays a significant role in monitoring patients on chronic opioid therapy (COT) for non-medical opioid use (NMOU). UDT, at times, can be inconsistent and misleading. We present a case where a patient on a buprenorphine patch had false negative results. A female in her 70s with metastatic breast cancer presented with uncontrolled pain from a T6 compression fracture. She had no relief with tramadol 50 mg every 6 hours as needed. Due to an allergic reaction to hydromorphone, our team prescribed a buprenorphine patch of 5 μg/h. Subsequently, she expressed excellent pain control, and the clinician confirmed the patch placement on examination. She underwent a UDT during the visit. The UDT was negative for both buprenorphine and its metabolites. The literature review showed that false negative UDT results are relatively common among patients with low-dose buprenorphine patches. The combination of a thorough physical examination, a review of the Prescription Drug Monitoring Program, and reassuring scores on screening tools placed her at low risk for NMOU. Buprenorphine has a ceiling effect on respiratory depression and a lower risk for addiction. However, when used in low doses, the drug might not have enough metabolites in the urine, leading to a false negative UDT. Such results might affect patient-physician relationships. In addition to the UDT, a thorough history, screening for NMOU, physical exam, a review of PDMP, and a good understanding of opioid metabolism are necessary to help guide pain management.

Comparison of the Analagesic Efficacy of Transdermally Applied Buprenorphine and Ketoprofen for Postoperative Abdominal Pain in Dogs

Transdermal drug delivery (TDD) is defined as the non-invasive delivery of medications through the skin surface. The present study was planned to evaluate the efficacy of transdermal drug delivery system to alleviate the post-operative pain after abdominal surgery. Twelve clinical cases of dogs presented to the Department of Veterinary Surgery and Radiology, VCC, College of Veterinary Science and A.H., Mhow were selected for the study and divided into two groups. In group I (n=6) ketoprofen transdermal patch and in group II (n=6) buprenorphine transdermal patch was applied to the skin. The Glasgow Composite Measure Pain Scale was used to assess the pain pre-operatively (1 hour before surgery), complete post recovery, 24, 48 and 72 h post operatively. The mean total pain score was maximum in ketoprofen group than the buprenorphine group. Serum glucose and serum cortisol values increased significantly (P&lt;0.05) in the animals of both the groups however, this increase was minimum in buprenorphine group at complete post recovery. Based on above study, it is concluded that buprenorphine transdermal patch was considered more effective for controlling the visceral pain in comparison to ketoprofen transdermal patch in dogs.

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

Background: Adequate pain management is an essential entity in reconstructive surgery to prevent adverse physiological and psychological outcome. Transdermal buprenorphine has been mostly studied in chronic pain and cancer related pain but hardly studies in acute pain are available. Aims and Objectives: The aims of this study were to compare post-operative pain relief achieved by transdermal buprenorphine and IV paracetamol in terms of safety and efficacy. Sedation and adverse effects were also studied. Materials and Methods: This is a prospective, parallel group, double-blind, and randomized trial. After ethics, clearance and consent from 46 patients undergoing major reconstructive surgery were allotted into Group B, (n=23) who received transdermal buprenorphine and Group P (n=23) who received m IV paracetamol 6 hourly. IV Paracetamol was taken as active control. Standard institutional protocol for general anesthesia was followed. Visual analog scale (VAS) score was measured postoperatively for 48 h. Diclofenac sodium was the rescue analgesic. Sedation was assessed by Ramsay Sedation score. Results: Transdermal buprenorphine patch (TDB) gave superior pain relief in comparison to intravenous paracetamol 48 h postoperatively, P≤0.0.5 pin VAS score. The total amount of rescue analgesic required was high in Group P than Group B (P=0.034). Hemodynamic stability was better maintained with TDB with minimal sedation and side effect. Conclusion: TDB (20 μg/h; 20 mg) can be safely used for post-operative analgesia with greater efficacy and minimal side effects when compared to intravenous paracetamol.

COMPARISON BETWEEN SAFETY AND EFFICACY OF TRANSDERMAL BUPRENORPHINE AND FENTANYL PATCHES FOR THE MANAGEMENT OF POST-OPERATIVE PAIN FOLLOWING LUMBAR SPINAL INSTRUMENTATION.

Introduction: Pain is a complex sensory perception. Post-operative pain management is multimodal. We compared transdermal fentanyl and buprenorphine patches for management of post-operative pain following lumbar spinal instrumentation. Material &amp; Methods: A sample size of 60 patients were included equally divided into 2 groups. Group B: Receiving transdermal buprenorphine at 10mcg/hr and Group F: Receiving transdermal fentanyl at 25mcg/hr. Transdermal patches were applied 6 hours before proposed surgery. Statistical analysis was done by SPSS version 25.0, In,Chicago II ,USA and Graph pad Prism version 5. Results &amp; Analysis: Analysis of different data vs group was not statistically significant. Conclusion: Buprenorphine transdermal patch (TDP) is better as it has less adverse events than fentanyl TDP which is a better analgesic

Evaluation of physical examination and thermal nociceptive threshold testing during placement of transdermal buprenorphine patch in healthy adult horses

Introduction: Transdermal buprenorphine patches have not previously been investigated in horses and could potentially be used for long-term analgesia without needing venous catheterization.

A Case of Acute Withdrawal Symptoms Due to Unplanned Interruption of Buprenorphine Transdermal Patch: With a Discussion Including Social Aspects of Home Medical Care Patients

【緒言】ブプレノルフィン経皮吸収製剤（BTDP）の自己中断により，急性オピオイド退薬症状を呈した在宅医療患者を報告する．【症例】84歳，在宅訪問診療利用中の男性．腰部脊柱管狭窄症の悪化により，4カ月前からBTDPで鎮痛されていた．症状改善傾向と考えた家人が，患者本人に無断でNSAIDs経皮吸収製剤に貼り替えたところ，約50時間後から5分ごとの頻尿や失禁，水様性下痢，発汗，血圧低下，足裏の不快感，不眠などの多彩な症状が表出された．Clinical Opiate Withdrawal Score（COWS）では12点の軽度退薬症状に該当した．発症後24時間で激しい症状はほぼ自覚されなくなり，48時間後には完全に消退した．【結論】BTDPの急速な中止による退薬症状の報告例は少ない．医学薬学的な側面のほか，在宅医療におけるオピオイド製剤使用上の社会的問題点も明らかとなった．

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

Dear Editor, Transdermal delivery system (TDS) is a simple, reliable, noninvasive analgesic delivery method that has been used extensively for chronic pain management. After application, drug in TDS forms a depot in the upper layers of skin that slowly increases serum concentration.[4] Both fentanyl and buprenorphine have high lipid solubility and low molecular weight which makes them ideal candidates for a TDS. The perceived advantages of TDS for acute postoperative pain include sustained blood level of the drug and reduced side effects. Transdermal buprenorphine (TDB) provides convenient once-weekly dosing, has ceiling effect for respiratory, lower abuse potential, and does not require dose alterations patients with renal dysfunction, unlike fentanyl (full μ-opioid receptor agonist).[1] Khandelwal et al. 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. The concentration of TDS drugs tends to be higher in the first 24 h and several factors like variability in body temperature, factors that increase cutaneous blood flow (warming blanket, sepsis or regional anesthesia), previous opioid use, hemodynamics, and patient’s general condition may make TDS opioid absorption unpredictable.[3] There have been reports of serious, life-threatening respiratory depression and death following transdermal fentanyl.[4] Buprenorphine is 60 times while fentanyl is 100 times as potent as morphine and the duration of action for fentanyl (3d) and TBD (7d) is different. So, equianalgesic doses of both[ratio 3:5]should be compared but the authors in the study have used a non-equianalgesic dosage (10:25 and 20:25). The peak effect comes in 12 h (fentanyl) to 24 h (buprenorphine). So, the patches are generally applied a day before surgery, but this may not be the ideal scenario in daycare settings. 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] Many dose formulations are available and according to recommendations from the manufacturer, opioid-naive patients should initially receive the lowest strength patch.[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] TDS are amenable to abuse, serious side effects like respiratory depression, and cognitive dysfunction, may increase duration of hospital stay and overall cost of daycare procedures. Despite their success for chronic pain management, TDS opioids for acute postoperative pain is a new and off-label use and should be undertaken if the benefits outweigh the risks involved. The main rebuke for TDS is its lack of titrability, long latency for onset, and slow offset making it an inferior alternative compared to other commonly used modes of analgesic delivery such as patient-controlled analgesia. Moreover, they are an expensive alternative to parenteral and oral drugs and may not be ideal in our setting. Hence, we would urge caution in the indiscriminate usage of TDS as a sole modality of postoperative analgesia until further robust evidence proves the contrary. Whenever chosen, they should be used in monitored settings for opioid naïve patients. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Efficacy of Transdermal Buprenorphine Patch in Postoperative Pain Management in Oral and Maxillofacial Surgery

Efficacy of Transdermal Buprenorphine Patch in Postoperative Pain Management in Oral and Maxillofacial Surgery

Randomised controlled trial of intramuscular tramadol versus transdermal buprenorphine patch for early postoperative surgical pain.

This study assesses the efficiency of the buprenorphine patch system compared to the routine use of tramadol intramuscular injections in the context of the South African public healthcare sector. Patients were randomised into two groups, who received routine tramadol injections 100 mg every 8 hours intramuscular and buprenorphine patches 5 mcg every hour. The study assessed the first 48 hours postoperatively. A visual discrete pain scale was used to assess the level of postoperative pain as well as all complications associated with insufficient analgesic administration. The sample size included 75 patients in the tramadol group and 75 patients in the buprenorphine patch group. Nine patients (12%, p-value < 0.0001) who received the buprenorphine patch subsequently required additional analgesia. The pain score was found to be significantly less in the buprenorphine patch group on both day 1 and day 2, as were complications such as vomiting, nausea, nightmares, sweating and insomnia. The pain score in the buprenorphine group as significantly lower compared to the tramadol group. The use of the buprenorphine patch showed a slight increase in costs compared to the tramadol group (R7 800.75 vs R7 537.50; p-value 0.483) in the whole study. The study showed that the use of the buprenorphine patch is a reliable and effective method of postoperative analgesia, although it is slightly more expensive compared to the routine use of tramadol. The buprenorphine patch showed significantly better results in all assessed parameters; thus, it may be recommended for use at the Dr George Mukhari Academic Hospital (DGMAH).

Comparison of Efficacy and Safety of Transdermal Buprenorphine Patch and Conventional Analgesics in Intra-capsular Femur Neck Fracture Post Hemiarthroplasty.

One of the most common fractures in the elderly population is a fracture of the neck of femur. Effective post-operative analgesia is a major challenge. Age-related co-morbidities restrict the choice of analgesics. The purpose of this study was to compare the efficacy and safety of transdermal buprenorphine [TDB] patch and conventional analgesics following hemiarthroplasty for intra-capsular fracture neck of femur. This was a prospective, randomized control study done in 60 patients undergoing hemiarthroplasty for intra-capsular fracture neck of femur over a period of 2years. Patients were randomized in 2 groups. Group A received a combination of IV paracetamol and tramadol for first 48h followed by oral formulation. In Group B patients, a transdermal buprenorphine patch of 5mcg/h was applied at the beginning of surgery and was continued 2weeks post-operative.Pain score by VAS was observed both at rest and on movement and followed up till 14days post-operative. Primary target was to maintain a VAS ≤ 4. Rescue analgesic was given if the VAS was ≥ 6. Secondary targets were number of rescue analgesics required, adverse reactions and complications if any. Group B had significantly lower pain scores at rest and during movement [p value 0.0012 to ≤ 0.0001], so was rescue analgesia requirement. No significant side effects were seen in TDB group. TDB patch is safe and provides superior analgesia and compliance as compared to conventional analgesics in the post-operative period in proximal femur fracture surgeries.

Comparisons of Transdermal Buprenorphine Patch versus Transdermal Fentanyl patch for postoperative analgesia in lower limb orthopedic surgery

Background: Postoperative pain are acute, moderate to severe type. Lower limb orthopedic surgeries are subset of surgerywhich requires multimodal analgesia postoperatively as it requires excellent postoperative analgesia for early orthopedicrehabilitation as well. Transdermal opioid patches is a part of this multimodal analgesia regimen for postoperative painrelief.Material and method: The study was conducted after Institutional Ethical committee approval, and informed writtenconsent taken from all participants. 60 patients enrolled for this study of ASA 1 and ASA 2 grade, either gender postedfor lower limb orthopedic procedure. The patients were assessed preoperatively and patches applied 6hrs prior surgery.All patients received paracetamol 1gm as rescue analgesic. Total duration of analgesia, requirement additional analgesicnoted, panic evaluated with VAS and any side effects also noted for 3 days .Results: The visual analogue scale shows significant values in the fourth [Group B] and eight hours [Group F] hours of thepost-operative period. 0.0005 is the p-value. Pruritus was more common in group F which was statistically significant ascompared to the group a. Pruritus was seen in six patients in group F but only two patients in Group B. Group F showedmore incidence of nausea/vomiting as well as more requirement of antiemetic as compared to other groups, but it wasnot statistically significant.Conclusion: In lower limb arthroscopic procedures, buprenorphine patch was shown to be more effective than fentanylpatch for postoperative pain, with no increased hemodynamic instability or side effects.

Novel Opioid Analgesics for the Development of Transdermal Opioid Patches That Possess Morphine-Like Pharmacological Profiles Rather Than Fentanyl: Possible Opioid Switching Alternatives Among Patch Formula.

BACKGROUND:Transdermal fentanyl is widely used in the treatment of severe pain because of convenience, safety, and stable blood concentrations. Nevertheless, patients often develop tolerance to fentanyl, necessitating the use of other opioids; transdermal buprenorphine patch is widely used as an analgesic agent, though available formulation does not provide comparable analgesic effect as transdermal fentanyl patch. Opioids bind to the opioid receptor (OR) to activate both G protein–mediated and β-arrestin–mediated pathways. We synthesized morphine-related compounds with high transdermal absorbability (N1 and N2) and evaluated their OR activities pharmacologically in comparison with fentanyl and morphine.METHODS:In cells stably expressing μ-opioid receptor (MOR), δ-opioid receptor (DOR), and κ-opioid receptor (KOR), G protein–mediated pathways were assessed using the CellKey and an intracellular cyclic adenosine monophosphate (cAMP) assay, while β-arrestin–mediated pathways were analyzed with β-arrestin recruitment and receptor internalization assays. Furthermore, analgesic effects were evaluated using a tail-flick test in mice, and the analgesic effect on fentanyl-tolerant mice was evaluated.RESULTS:In the CellKey and cAMP assays, both N1 and N2 showed the highest affinity for MOR and acted as full agonists as well as partial agonists for DOR and KOR. In the β-arrestin and internalization assays, only fentanyl acted as a full agonist; N1 and N2 acted as partial agonists of MOR. In the mouse tail-flick test, N1 and N2 showed analgesic effects equivalent to those of fentanyl and morphine. In fentanyl-tolerant mice, fentanyl showed a diminished analgesic effect, whereas N1 and N2 as well as morphine retained their analgesic effects.CONCLUSIONS:While N1 and N2 have higher transdermal absorbability than fentanyl, they also have analgesic effects comparable to those of morphine, suggesting that they may be attractive compounds for the development of novel opioid patches for transitioning from fentanyl patches.

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

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 &gt;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.

Morbidity Pattern in Sickle Cell Disease in Central Gujarat, India — Single Centre Perspective

INTRODUCTIONSickle cell disease (SCD) poses a considerable health burden in India. About 20 per cent of children with SCD die by the age of two and 30 per cent children with SCD among the tribal community die before they reach adulthood is reported in one ICMR survey. As they are vulnerable to mortality, require regular clinical follow up. This retrospective analysis study was, undertaken to evaluate the morbidity pattern in SCD patients observed in patients followed up at our centre METHODSSCD patients registered and followed up at HOCC between Jan 2011 to June 2017 were included in this study. At first visit to HOCC baseline CBC, PLT, RBC indices, LFT, Creatinine, S.Ferritin,Urine R/M,HPLC pattern,USG abdomen were noted. All 342 patients registered at HOCC were advised to take Hydroxyurea (dose adjusted according to CBC), Folic acid, B12, Multivitamin and Calcium. Vaccination given to selected patients. Out of these 342 patients, 57(16%) patients had 79 hospitalization events, 11 patients (3.2%) had recurrent hospitalizations. All patients were hospitalized in Sterling Hospital Vadodara.CBC PLT,RBC indices,LFT, RFT done on admission in all patients, Blood and urine culture, PS for MP, Dengue NS1,IgG,IgM, in all febrile patients, Viral markers ,CXR,USG Abdomen, MRI pelvis with HIP done in selected patients. All hospitalized patients received adequate hydration by IV fluids.Paracetamol, Contramol, Buprenorphine transdermal patch for pain relief. PCV transfusion to keep HB 8 to 10 gm%.Antibiotics if any evidence of infection, pre-emptive or based on culture report.Oxygen by nasal prongs or NRBM,NIV or Invasive Ventilator support to maintain SPO2 more than 95%.Exchange transfusion if no pain relief in vasoocclusive crisis in 48 hrs or has Acute Chest Syndrome, Splenic Sequestration or Hepatic cell crisis RESULTSSeventy nine hospitalization events of 57 SCD patients during study period were evaluated to analyse morbidity pattern. Out of 57 patients 47 (82%)patients were not taking regular treatment,10 patients (17%)inspite of regular treatment and follow up developed morbid events .Age range 7 yrs to 57 years, M:F ratio 2:1(Male 38,Female 19),5(8%) patients were pregnant ,Vaso-occlusive crisis was most common morbid event 46(58% ) followed by LRTI,ARDS,Acute chest syndrome 9(11%),Hepatic cell crisis 8(10%),Septicemia 6(7.5%),Splenic sequestration 3(3.7%), Aplastic crisis 2(2.5%),Dengue 2(2.5%),Vivax Malaria 2(2.5%),AVN 2(2.5%).Septic arthritis 1(1.2%),Majority of hospitalization observed in month of July and Aug followed by in September ,October, least admissions in the month of April and December,HB F level was more than 20% in 16 patients(28%) and between 10 to 20 % in remaining patients(72%).Duration of hospitalization less than 10 days in majority 69(87%),14 days in 10(12%),Ventilator support was required for 7(8.8%) ,O2 by NRBM in 2(2.5%) ,O2 by nasal prongs 1(1.2%),Blood and Urine Culture for gram negative bacterial growth detected in 6(7.5%),none of the patient had gram positive growth, Exchange transfusion was required for 19 patients(24%) Outcome was favourable in 75(94%),whereas 4 patients(5%) who were not on regular follow up and they reached hospital almost 72 hrs after initial symptoms of crisis succumbed ,Major cause of mortality was Hypoxia, Septicemia with multiorgan failure on day1 of admission in hospital with rapid deterioration within 24 hrs. CONCLUSIONSCD patients on Hydroxyurea and supportive therapy have significantly lower incidence of morbid events requiring hospitalization.Vaso-occlusive crisis is a major reason of hospitalization. Gram negative septicaemia is the leading cause of infective morbidity. Hepatic cell crisis observed predominantly in ethanol addicted patients, Mortality is highest with delayed treatment of ARDS, Acute chest syndrome. Four strong predictors of good outcome are adequate hydration, early control on infection, maintaining adequate oxygenation and early initiation of treatment before organ failure sets in. DisclosuresNo relevant conflicts of interest to declare.

Post-surgical analgesia management with transdermal buprenorphine patch on a patient with compartment syndrome after tibia plateau fracture with multiple operations before the end of his rehabilitation

Introduction: Buprenorfine is a semisynthetic opioid which is used as a therapeutic substitute of opioid drugs and as medium to strong painkiller in smaller doses for the management of chronic pain. It’s first use goes back in 80’s. The use of buprenorphine as therapeutic substitute was approved in 2002 in USA and 2006 in Europe. The administration of buprenorphrine, in contrast to other opioids, does not provoke euphoria. It binds as an agonist/antagonist to μ and κ receptors of the brain and last up to 72 hours. Compartment syndrome is a serious pathological situation where we have increased pressures within a compartment. Compartment is a group of muscles, blood vessels and nerves which are surrounded by a strong membrane called fascia attached to bone. Fascia cannot be expanded therefore the oedema within a compartment can lead to increased pressures. As a result, it can create muscle, vessel and nerve damage. The increased compartment pressure can block the blood flow in the compartment and lead to lack of oxygen in tissue (ischemia) and cellular death. Patient feels an acute pain, unbearable as described and strong opioids provide moderate pain relief. Purpose of the current study is to evaluate the analgesia and efficiency of buprenorphine patch not only in patients with chronic pain but as post surgical analgesia in patients who suffered compartment syndrome and need multiple operation before the end of the rehabilitation. Case presentation: A male patient, 36 y.o. with no past medical history attend A/E department after a fall from height and intense knee and proximal tibia pain. He suffered from a tibia plateau fracture. Neurovascularly was compromised with absence of pulses in posterior tibial artery, reduced sensation in the anterior compartment of the tibia and the passive movement of the toes triggered excruciating pain. Lower limb vein triplex was performed to exclude DVT. Clinical diagnosis of compartment syndrome was done and the patient was taken to OR where fasciotomy both sides was performed and all four compartments were released. Copious haematoma was evacuated[1] Breivik H, Ljosaa TM, Stengaard-Pedersen K, Persson J, Aro H, Villumsen J, et al. A 6-months, randomised, placebo-controlled evaluation of efficacy and tolerability of a low-dose 7-day buprenorphine transdermal patch in osteoarthritis patients naive to potent opioids., a bridging femur tibia ex fix was applied and the wound left open. The phased closure of the trauma was achieved in four stages within the next 30 days. Outcome and follow-up: Spinal anaesthesia was the preferred method and for the post-op pain management was applied transdermic buprenorphine patch 70mcg in combination with 1 gr three times a day of IV paracetamol. Gradual decrease of buprenorphine dose lasted for the period the wound was open until the final closure and the reduction of the fracture. Acute and continuous pain is constant in the post op period in patients with long bone fractures complicated with compartment syndrome. Most of the times the pain can not be managed with routine analgesia, even with the additional use of opioids. With the application of buprenorphine patch on the specific patient, the pain was not only significantly reduced but also was not in need of any additional painkillers. The Visual Analog Scale (VAS) was 2to 3 the first week and 1 to 2 the second. Discussion: Anaesthetists are familiar with the pain management and their administration methods. Post op analgesia methods and their application is part of the ongoing perioperative pain management. The new semisynthetic opioids offer excellent challenges and opportunities to use and study their field of application not only for the chronic malignant pain but with also for post op analgesia under constant monitoring. It can provide sufficient and safe analgesia in difficult cases such as the tibia plateau fracture in combination with the compartment syndrome.