Effectiveness of Transdermal Buprenorphine for Pain Control in the ICU After Major Surgical Procedures

OBJECTIVES:Transdermal buprenorphine (TBUP) may be useful for postoperative pain after major surgery, when pain is expected to be severe and sustained. The objective of this study was to compare pain control and opioid consumption in critically ill postoperative patients who were treated with TBUP or not during ICU admission.DESIGN:This was a retrospective, parallel, cohort study.SETTING:ICU of a quaternary, urban hospital in Sydney, Australia.PATIENTS:Data were obtained for all patients admitted to the ICU from January 2019 to July 2021 after major gastrointestinal (GI) or genitourinary (GU) surgery.INTERVENTIONS:TBUP or non-TBUP.MEASUREMENTS AND MAIN RESULTS:Pain control was compared between patients who received TBUP and those who did not receive TBUP. The primary outcome was the probability of significant pain. A significant pain score was defined as greater than or equal to 4 on the 0-10 numeric rating scale or greater than or equal to 6 on the behavioral pain scale. Inverse probability of treatment weighting was used to adjust for baseline differences. The cohort included 376 patients, with 224 (60%) in the control group and 152 (40%) in the TBUP group. The mean age was 60 +/- 14 years, 202 (54%) were male, mean Acute Physiology and Chronic Health Evaluation III score was 44 +/- 13, and 147 (39%) received mechanical ventilation. After adjustment, the median probability of significant pain was 0.25 with control and 0.30 with TBUP (median difference, 0.02; 95% CI, 0.04-0.11; p = 0.44). The median opioid consumption (oral morphine milligram equivalents) per day was 5.7 mg with control and 10.1 mg with TBUP (median difference, 0.4 mg; 95% CI, -0.4 to 3.7 mg; p = 0.31).CONCLUSIONS:In patients who are admitted to the ICU after major GI or GU procedures, the use of TBUP in the ICU was not associated with improved pain control or opioid consumption compared with those who did not receive TBUP.