Buprenorphine for acute pain in older adults: a systematic review with meta-analysis

Background Buprenorphine, a partial opioid agonist, has emerging evidence as an alternative to full agonist opioids for treatment of acute pain. This systematic review aimed to evaluate the safety and efficacy of buprenorphine for acute pain in older adults.Methods PubMed Medline, Embase, Cochrane Central Register of Controlled Trials, CINHAL, Web of Science database, and Google Scholar were searched. We included articles that reported buprenorphine as an intervention to treat acute pain among patients 60 years or older. Primary outcome was difference in pain scores for patients treated with buprenorphine compared to other analgesia. Secondary outcomes included adverse events, opioid consumption, and patient satisfaction. Meta-analysis was conducted on difference in pain scores and differences in nausea and vomiting.Results Twenty-two studies were included (n = 2610). Buprenorphine was administered as nerve blocks in 6 studies, transdermal in eight, intravenous or intramuscular in 5, sublingual in 2 studies, and both intravenous and sublingual in one study. 10 out of 20 (50%) studies found improved pain control in buprenorphine groups. Meta-analysis found no significant difference in pain scores between buprenorphine and control analgesia at 24 hours [Cohen's d = -0.29 (95% confidence interval (CI) -0.85 to 0.27)] and 7 days [Cohen's d = -0.89 (95% CI -2.66 to 0.88)]. Six studies (54.5%) found reduced opioid consumption in patients receiving buprenorphine. There was no difference in adverse effects in most studies.Conclusions This review did not find buprenorphine to be superior to alternative analgesia; however, the mixed results provide scientific rationale for future studies testing buprenorphine in older populations.