Transdermal Buprenorphine patch provides superior analgesia as compared to conventional analgesics

Sanjay Bhalchandra Londhe et al conducted a prospective, randomized control study to compare the efficacy and safety of transdermal buprenorphine (TDB) patch and conventional analgesics following hemiarthroplasty for intra-capsular fracture neck of femur. The article has been published in Indian journal of orthopedics. The authors found that 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.

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 study included 60 patients undergoing hemiarthroplasty for intra-capsular fracture neck of femur over a period of 2 years. Patients were randomized in 2 groups Group A received a combination of IV paracetamol 1 gm TID and tramadol 50 mg BID for first 48 h followed by oral formulation in the dose of 650 mg acetaminophen+50 mg tramadol three times a day for 14 days.

In Group B patients, a transdermal buprenorphine patch of 5mcg/hr was applied at the beginning of the surgery. The same was replaced by another patch at the end of first week. The second patch was continued till 14th post-operative day. Pain score by VAS was observed both at rest and on movement and followed up till 14 days post-operative.

IV/ oral diclofenac 50 mg was used as a rescue analgesic in either group if VAS score was ≥ 6/10. If VAS was ≥ 5/10, an additional dose of NSAID was given as secondary rescue. Primary target was to maintain a VAS≤4. Secondary targets were number of rescue analgesics required, adverse reactions and complications if any.

The results of the study were –

• The mean duration between the injury and the surgical intervention was 35.5±6.5 and 37.5±3.5 h. in Group A and Group B respectively, statistically not significant (p value 0.1433).

• The baseline pre-operative VAS scores were similar in both groups (VAS score 7–10) with a mean of 6.9±2.3 and 7.1±1.8 respectively in groups A and B. p value was 0.7090 which is statistically insignificant.

• 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.

The authors concluded that - TDB patch is safe and effective for managing post-operative pain after hemiarthroplasty for intra-capsular fractured neck of femur. It provides superior analgesia, better patient satisfaction and lower incidence of adverse effects as compared to conventional analgesics.

Further reading:

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

Sanjay Bhalchandra Londhe, Meghana Patwardhan et al

Indian Journal of Orthopaedics (2022) 56:1363–1369

https://doi.org/10.1007/s43465-022-00668-7