Skin abscess after the use of transdermal buprenorphine. Case report / Abscesso cutâneo após o uso de buprenorfina transdérmica. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Buprenorphine is a partial agonist semi-synthetic opioid used as an option in the treatment of patients with moderate to severe pain. The only presentation of buprenorphine available in Brazil is for transdermal use. This is an important route of drug administration, especially for the treatment of chronic pain, as it has several advantages, however it is not free from complications. The objective of this study was to present a serious adverse skin reaction after the use of transdermal buprenorphine, requiring surgical intervention. CASE REPORT: Female patient, 63 years old, hypertensive and diabetic, diagnosed with rheumatoid arthritis, fibromyalgia syndrome and lumbar disc herniation, with severe chronic pain, advised to use transdermal buprenorphine 10 mg to help control algic. After 24 hours of use, the patient developed erythema and local itching, requiring removal of the adhesive, but the lesion progressively worsened with the formation of an abscess and the need for surgical drainage. CONCLUSION: Transdermal buprenorphine has a favorable safety and tolerability profile, as it reduces the risk of unwanted effects such as respiratory depression, constipation and suicidal ideation. However, its use in senior patients with comorbidities, such as the immunosuppression described in this case, requires greater vigilance, due to the possibility of developing more serious adverse reactions.

RESUMO JUSTIFICATIVA E OBJETIVOS: A buprenorfina é um opioide agonista parcial semissintético utilizado como opção no tratamento de pacientes com dor de moderada a intensa. A única apresentação disponível da buprenorfina no Brasil é para uso por via transdérmica. Esta é uma via importante de administração de fármacos, principalmente para o tratamento de dor crônica, já que apresenta diversas vantagens, no entanto não é isenta de complicações. O objetivo deste estudo foi apresentar uma reação cutânea adversa grave após o uso de buprenorfina transdérmica, com necessidade de intervenção cirúrgica. RELATO DO CASO: Paciente do sexo feminino, 63 anos, hipertensa e diabética, com diagnósticos de artrite reumatoide, síndrome fibromiálgica e hérnia de disco lombar, portadora de dor crônica intensa, com orientação de utilizar buprenorfina transdérmica 10 mg para auxiliar o controle álgico. Após 24 h de uso, a paciente evoluiu com eritema e prurido local, sendo indicada a remoção do adesivo, porém a lesão piorou progressivamente com formação de abscesso e necessidade de drenagem cirúrgica. CONCLUSÃO: A buprenorfina transdérmica apresenta um perfil favorável de segurança e tolerabilidade, pois reduz o risco de efeitos indesejados, como depressão respiratória, constipação e ideação suicida. No entanto, seu uso em pacientes idosos portadores de comorbidades, como a imunossupressão descrita no caso, exige maior vigilância, devido à possibilidade de desenvolvimento de reações adversas mais graves.

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

Introduction: Since the commercial availability of buprenorphine extended-release transdermal patches (BTDP) from the early 2010’s, the therapeutic indications for opioids have widely expanded to include chronic benign diseases. We report a case of a home health care patient with acute opioid withdrawal symptoms due to self-interruption of BTDP. Case: An 84-year-old man using home health care services due to worsening of lumbar spinal canal stenosis had been receiving analgesia with a BTDP, a mixed opioid agonist/antagonist analgesic, for the preceding five months. Since the patient's spouse thought that his pain and symptoms were gradually improving, she secretly replaced the BTDP with an NSAID patch without informing the patient. About 50 hours later, the patient experienced a variety of symptoms, including frequent urination with incontinence every five minutes, watery diarrhea, sweating, decreased blood pressure, discomfort in the feet, and insomnia. Evaluation of the Clinical Opiate Withdrawal Score (COWS) by the home health care physician indicated a score of 12, corresponding to mild withdrawal symptoms. About 12 hours after symptom onset, the severe abnormalities were barely noticeable and completely disappeared after two days. Conclusion: Few previous case reports have described withdrawal symptoms due to rapid discontinuation of BTDP. In addition to the medical considerations, we report the social issues associated with onset of the condition in a home environment. Opioid use for non-cancer pain requires medication management from a different perspective than that for cancer pain.

Efficacy and Safety of Transdermal Buprenorphine Patch for Cancer Pain Relief in Elderly Patients : A Retrospective Study from a Tertiary Care Centre of Eastern India

Cancer is one of the leading causes of morbidity and mortality worldwide & cancer pain is experienced by patients with advanced, metastatic and terminal disease. Buprenorphine, a partial µ-receptor agonist and antagonist at the kopioid receptor, shows no clinically relevant accumulation of active metabolites, and pharmacokinetics remain unchanged in renal insufficiency. In elderly cancer patients, the use of opioids for control of cancer pain is a therapeutic challenge, as these group of patients often associated with renal and hepatic comorbidity that limited the use of strong opioids like morphine. Methods : A retrospective observational study was conducted in elderly patients to estimate the efficacy of transdermal buprenorphine patch for controlling of cancer pain as well as to assess the safety of the patch. For pain control Numerical Rating Score (NRS) was used & for safety assessment Grade 3 or 4 toxicity were recorded.Hepatic & renal toxicity were measured at baseline, at 1st month & at 3rd month of treatment & lastly at 6th month of treatment. Results : Majority of the patients showing good to excellent global satisfaction with Buprenorphine patch and 57% of patients suffered from constipation along with 38% nausea & vomiting. It was found that there was a significant reduction in pain intensity from baseline with a p value of <0.05. There was no significant hepatic or renal toxicity found in the study. Conclusion : Transdermal buprenorphine patch is effective and safe in elderly cancer patients for pain control. Further studies should be performed in order to find safe and effective opioid methods necessary to give greater insight into the difficult balance between analgesia and toxicity

Analgesia postoperatoria para craneotomías en pediatría: experiencia en un Hospital de Tercer Nivel / Postoperative analgesia for craniotomies in pediatrics: experience in a Third Level Hospital

Resumen: Introducción: Existe la creencia de que los pacientes no experimentan dolor intenso después de cirugía intracraneal. La estimulación simpática secundaria a dolor puede ocasionar hipertensión intracraneal y sangrado postoperatorio. Es controvertido el uso de opioides para analgesia postcraneotomías por temor a sus efectos colaterales que pueden enmascarar signos de alteración neurológica. En pediatría hay estudios limitados. Objetivo: Describir el nivel de control del dolor postcraneotomías al usar buprenorfina ketorolaco y ondansetrón en pacientes pediátricos. Métodos: Estudio de cohorte descriptivo. Incluimos niños de 0-17 años programados para cirugía intracraneal electiva. Para el control del dolor se administró buprenorfina, ketorolaco y ondansetrón en infusión por 30 horas. Se investigó dolor al iniciar la infusión a las cuatro, ocho, 12, 24 y 30 horas; variables hemodinámicas y grado de sedación. Resultados: 109 pacientes fueron incluidos. Se observó adecuado control del dolor en 71.56%, 28.4% tuvo control insuficiente con una diferencia estadísticamente significativa (p < 0.001). Hubo sedación moderada en 5.6% iniciando la infusión y a las 24 horas (4.5%) sin repercusión hemodinámica. Se detectó náusea en 8.2% y vómito en 6.64%; no se presentó sedación profunda, ni depresión respiratoria. Conclusiones: Estos hallazgos sugieren que es una opción efectiva para tratar el dolor postcraneotomías en pediatría.

Abstract: Introduction: There is still a belief that patients do not experience intense pain after intracranial surgery. Sympathetic stimulation associated with pain can lead to elevated intracranial pressure and postoperative haemorrhage. There is controversy about the use of opioids for postoperative analgesia in craniotomies, owing to fear of its side effects, which can mask signs of neurological alteration. There are limited studies in the pediatric patient for post-craniotomy analgesia. Objective: To describe the postcraneotomies pain control level, using buprenorphine in partnership with ketorolac and ondansetron in pediatric patients. Methods: Descriptive cohort study. For postoperative pain control, patients were given continuous infusion buprenorphine, ketorolac and ondansetron for 30 hours. The main variables to investigate were pain at beginning of infusion, at four, eight, 12, 24 and 30 hours, hemodynamic variables and depth of sedation. Results: 109 patients were included. Adequate control of pain was observed in 71.56% of patients, whereas in 28.4% insufficient control was found, with a statistically significant difference (p < 0.001). There was moderate sedation in 5.6% of the patients at the start of infusion and at 24 hours (4.5%), without significant impact on hemodynamic variables. Nausea was found in 8.2% and vomiting in 6.64%. No deep sedation, or respiratory depression was presented. Conclusions: These findings suggest that is an effective option to treat postcraneotomy pain in pediatric patients.

Exploración de la eficacia analgésica de dos parches transdérmicos analgésicos de opioides, buprenorfina y fentanilo, según sus variaciones de dosis en el control del dolor en pacientes paliativos oncológicos / Exploration of the analgesic efficacy of two-transdermal analgesic patches of opioids, buprenorphine and fentanyl, according to their dose variations in pain control in palliative cancer patients

Objetivo: El presente trabajo de investigación tuvo como objetivo explorar la eficacia analgésica mediante la comparación de la respuesta analgésica de los parches transdérmicos (PTD) de buprenorfina y fentanilo en dolor oncológico y patrón de uso. Material y Método: Se obtuvieron los datos y variables desde los registros clínicos de pacientes ingresados a la Unidad de Cuidados Paliativos (UCP) del Instituto Nacional del Cáncer (INC) que estaban bajo tratamiento en mayo del 2017. Se incluyó en este estudio a 78 pacientes con PTD, que representan el 13% de los pacientes en control mensual. De estos, 66 estaban bajo tratamiento con buprenorfina y 8 bajo tratamiento con fentanilo. Resultados: Los resultados mostraron que el PTD de buprenorfina se utiliza más frecuentemente que el de fentanilo. El principal motivo de rotación fue dolor no controlado, seguido por imposibilidad de contar con la administración por vía oral. En pacientes con mayores intensidades de dolor somático o visceral se indicó fentanilo y en aquellos con componente neuropático se prefirió el uso de buprenorfina. PTD de fentanilo fue indicado en dosis mayores que buprenorfina, incluso al comparar sus dosis equianalgésicas, siendo la variación de dosis alta para ambos parches: aumentó en promedio 257%. Se logró una mejor respuesta analgésica con buprenorfina, con una variación de intensidad de escala numérica verbal (ENV) de 2,94 y 1,88 puntos de promedio para buprenorfina y fentanilo, respectivamente. Adicionalmente, se presentó mayor reacción local dérmica con fentanilo. Conclusiones: Se evidenció diferencias en patrón de uso y, a diferencia de lo esperado, se obtuvo una mejor eficacia analgésica con buprenorfina. Datos que deben ser corroborados en estudios con mayor número de pacientes bajo tratamiento con fentanilo.

Objective: This study aims to explore analgesic efficacy comparisons of buprenorphine and fentanyl transdermal patches (TDP) in cancer pain and it's usage pattern. Material and Method: Data and variables were collected from patient's clinical reports who were admitted in the National Cancer Institute's (NCI) Palliative Care Unit (PCU) and were under treatment with TDP in May 2017. 78 TDP patients were studied and represented 13% of the monthly control patients in the PCU. Of these, 66 were under buprenorphine treatment and 8 under fentanyl treatment. Results: The results showed that buprenorphine TDP is more frequently used than fentanyl TDP, and the main reason for exchange between them was uncontrolled pain, followed by oral administration impossibility. Fentanyl TDP was indicated in patients with higher somatic or visceral pain intensities and Buprenorphine TDP was preferred in patients with neuropathic pain. Fentanyl TDP was indicated in higher doses than buprenorphine, even when comparing its equianalgesic doses, the dose variation was high for both patches throughout the treatment: it increased on average by 257%. A better analgesic response was achieved with buprenorphine, with a variation of intensity of the Verbal Numerical Scale (VNS) of 2.94 and 1.88 average points, for buprenorphine and fentanyl respectively. Additionally, there was a higher local dermal reaction with fentanyl TDP. Conclusions: Differences in usage patterns were evidenced and, unlike what was expected, better analgesic efficacy was obtained with buprenorphine TDP. This data should be corroborated in receiving fentanyl treatment.

Transdermal buprenorphine for acute postoperative pain: a systematic review / Uso da buprenorfina transdérmica na dor aguda pós-operatória: revisão sistemática

Background and objectives: Postoperative pain is still a major concern in several surgical procedures. Multimodal analgesia is best for postoperative pain management; however, opioid therapy is still the main treatment for pain after surgical procedures. Transdermal buprenorphine is a partial µ-agonist opioid widely used for chronic pain syndromes, with limited evidence for acute postoperative pain. A systematic review of studies examining transdermal buprenorphine for acute pain management after surgery was conducted. Contents: Data from PubMed, Embase, The Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL via EBSCOhost, and LILACS were reviewed, including randomized clinical trials that evaluated total postoperative pain, postoperative analgesic consumption, drug-related side effects and patient satisfaction with analgesia regimen. Data from nine studies (615 patients) were included in this review. Most studies initiated transdermal buprenorphine use 6 to 48 hours before surgery, maintaining use from 1 to 28 days after the procedure. Most studies showed lower or similar postoperative pain scores, postoperative analgesic consumption and patient satisfaction comparing buprenorphine to placebo, tramadol, celecoxib, flurbiprofen and parecoxib. The incidence of side effects varied between studies, with most showing no increase in drug-related side effects with buprenorphine use, except one study, which compared buprenorphine to oral tramadol, and one to transdermal fentanyl. However, most results were derived from evidence with an overall high or unclear risk of bias. Conclusions: Although more studies are necessary, initial results show that transdermal buprenorphine seems to be an effective and safe opioid choice for management of acute postoperative pain

Justificativa e objetivos: A dor pós-operatória ainda é uma queixa importante em vários procedimentos cirúrgicos. A analgesia multimodal é a melhor conduta para a dor pós-operatória, embora a terapia com opioides ainda seja o principal tratamento para a dor após procedimentos cirúrgicos. A buprenorfina transdérmica é um opioide agonista µ amplamente prescrito nas síndromes de dor crônica, mas com limitada evidência do seu uso para dor aguda no pós-operatório. Realizamos revisão sistemática de estudos que examinaram o papel da buprenorfina transdérmica no tratamento da dor aguda pós-operatória. Conteúdo: Revisamos os dados de PubMed, Embase, Registro Central de Ensaios Controlados Cochrane (CENTRAL), CINAHL via EBSCOhost e LILACS, incluindo estudos clínicos randomizados que avaliaram a dor pós-operatória total, consumo de analgésicos pós-operatórios, efeitos colaterais relacionados a medicamentos e satisfação do paciente com esquema de analgesia. Dados de nove estudos (615 pacientes) foram incluídos nesta revisão. A maioria dos estudos iniciou o uso transdérmico de buprenorfina 6 a 48 horas antes da cirurgia, mantendo o uso de 1 a 28 dias após o procedimento. A maioria dos estudos encontrou valores semelhantes ou menores para o escore de dor pós-operatória, consumo pós-operatório de analgésicos e satisfação do paciente quando a buprenorfina foi comparada ao placebo, tramadol, celecoxibe, flurbiprofeno e parecoxibe. A incidência de efeitos colaterais oscilou nos estudos, e a maioria não mostrou aumento de efeito colateral relacionado ao uso de buprenorfina, exceto em dois estudos, um que comparou buprenorfina ao tramadol oral e outro ao fentanil transdérmico. No entanto, a maioria dos resultados foi obtida a partir de evidências com um risco geral alto ou risco de viés impreciso. Conclusões: Embora sejam necessários mais estudos, os resultados iniciais mostram que a buprenorfina transdérmica parece ser uma forma de administração segura e efetiva de opioide no tratamento da dor aguda pós-operatória

An Observational Comparative Study to Assess the Block Characteristics of Intrathecal Buprenorphine and Clonidine When Added to Bupivacaine for Orthopaedic Lower Limb Surgeries

Postoperative analgesia enables faster rehabilitation, improves the patient's level of satisfaction, and reduces hospital stay. Regional anaesthesia is the most common anaesthetic technique used for orthopaedic surgeries across the world. Adjuvants are often administered along with a local anaesthetic during spinal anaesthesia to prolong intraoperative and postoperative analgesia. The main objective of this study was to compare the effect of 60 mcg buprenorphine with that of 30 mcg clonidine when added to 3.2 ml bupivacaine with respect to onset and duration of sensory and motor block, maximum level of sensory block, duration of analgesia, and side effects if any.METHODSAfter obtaining institutional ethical committee clearance, a prospective observational study was conducted among 88 participants undergoing orthopaedic surgery of lower limb. Spinal anaesthesia was given, under aseptic precautions with 0.5% bupivacaine heavy 3.2 ml along with either 60 mcg buprenorphine (0.2 ml) or clonidine 30 mcg (0.2 ml). The buprenorphine receiving patients (n=44) were under group A and the clonidine receiving patients (n=44) were under group B. The heart rate, blood pressure, sensory block level, and duration of analgesia, were recorded.RESULTSAnalysis of the data shows that the use of clonidine significantly prolonged the duration of analgesia compared to buprenorphine. The incidence of hypotension, bradycardia, nausea and vomiting, etc. were similar in both groups.CONCLUSIONSUse of 30 mcg clonidine as an adjuvant in spinal anaesthesia provides significant prolongation of analgesia (mean duration of analgesia 190.5 minutes) compared to 60 mcg buprenorphine (mean duration of analgesia 157.5 minutes) without causing any increased incidence of adverse effects.

Buprenorphine with Local Anaesthetic Combination in Supraclavicular Brachial Plexus Block Produced Prolonged Post-operative Analgesia Compared to Butorphanol with Local Anaesthetic: A Prospective, Randomized, Comparative Study

Background: Supraclavicular approach for brachial plexus block offers an alternative anesthesia for upper extremity surgery.Addition of opioid agents in local anesthetic solutions for prolongation of analgesia through brachial plexus block has beenvery effective in controlling post-operative pain. The time to request for the 1st dose of rescue analgesia can be prolonged byadding buprenorphine or butorphanol in local anesthetic solutions.Methodology: After institutional ethical committee approval, 60 American Society of Anesthesiologists I/II patients wererandomized for this study. They belong to either gender, aged between 18 and 55 years of age. Patients who required brachialplexus block through supraclavicular approach were included and the study drugs were administered according to groupallocation into Group I and Group II. Sensory and motor block characteristics were monitored and recorded in all patients,complications as well. Hemodynamic monitoring was done every 5 min interval in the intraoperative period and every 15 minintervals in the post-operative period. Patients were administered rescue analgesia postoperatively when visual analog scale(VAS) scores were ≥4. Data were analyzed statistically.Results: Onset time to sensory block was 3.1 (1.1) min in Group I and 4.9 (1) min in Group II, and there was statistically significantdifference between groups (P < 0.0001). Onset time to motor block was 5.4 (1.3) min in Group I and 9.3 (1.5) min in Group II,and the difference between groups was found to be significant statistically (P < 0.0001). The time to 1st request of analgesiawas found to be statistically significantly between I and II groups (354.8 [55.6] vs. 448.3 [34.4] min, P < 0.0001), respectively.Conclusion: Both buprenorphine and butorphanol produced effective analgesia in combination with local anesthetics withoutsignificant side effects, but buprenorphine produced prolonged analgesia when compared to butorphanol.

To Compare and Assess Quality of Analgesia and Side Effects following the use of Fentanyl, Buprenorphine Hydrochloride, Bupivacaine Hydrochloride, through the Thoracic Epidural Catheter

Introduction: Epidural anaesthesia and analgesia hasjustified use in the perioperative care of high-risk surgicalpatients, as they give better analgesia, and also improvedoutcome. Thoracic Epidural analgesia is an excellent methodof postoperative and post injury pain control in proceduresinvolving significant thoracic and abdominal injury weathertraumatically or surgically induced. Though Bupivacaine isconsidered to be the drug of choice, many other agents arebeing used for epidural anesthesia.Material and Methods: This study was carried out on 105ASA grade I and II nulliparous patients, between 20 to 70 yearsof age undergoing laparotomy, voluntary donor nephrectomyand renal surgeries. They were randomly divided in theBuprenorphine, Bupivacaine and Fentanyl Groups. Quality ofanalgesia and post-operative complications were monitored.Results: Analgesic failure was observed in all the threeGroups. But complete pain relief was better in theBuprenorphine Group. Also, complications (hypotension,bradycardia, sedation) were less in the Buprenorphine Groupthan in the Bupivacaine and Fentanyl Groups.Conclusion: Buprenorphine is safer and provides betterquality analgesia than Bupivacaine and Fentanyl.

Assesment of Insulin Resistence in Different Stages of Chronic Kidney Disease

Introduction: Epidural anaesthesia and analgesia hasjustified use in the perioperative care of high-risk surgicalpatients, as they give better analgesia, and also improvedoutcome. Thoracic Epidural analgesia is an excellent methodof postoperative and post injury pain control in proceduresinvolving significant thoracic and abdominal injury weathertraumatically or surgically induced. Though Bupivacaine isconsidered to be the drug of choice, many other agents arebeing used for epidural anesthesia.Material and Methods: This study was carried out on 105ASA grade I and II nulliparous patients, between 20 to 70 yearsof age undergoing laparotomy, voluntary donor nephrectomyand renal surgeries. They were randomly divided in theBuprenorphine, Bupivacaine and Fentanyl Groups. Quality ofanalgesia and post-operative complications were monitored.Results: Analgesic failure was observed in all the threeGroups. But complete pain relief was better in theBuprenorphine Group. Also, complications (hypotension,bradycardia, sedation) were less in the Buprenorphine Groupthan in the Bupivacaine and Fentanyl Groups.Conclusion: Buprenorphine is safer and provides betterquality analgesia than Bupivacaine and Fentanyl.

Comparison of hemodynamic response and postoperative pain score between general anaesthesia with intravenous analgesia versus general anesthesia with caudal analgesia in pediatric patients undergoing open-heart surgery

Context: Regional anesthesia may attenuate adverse physiological stress responses associated with cardiothoracic surgery. In this study, hemodynamic stress response at the different time of surgical stimuli was compared between patients receiving general anesthesia (GA) along with caudal epidural analgesia with GA with intravenous analgesia in pediatric population undergoing open-heart surgery. Aims: This study aims to compare the hemodynamic response at the different time of surgical stimuli and postoperative pain score, in pediatric patients undergoing open-heart procedures. Settings and Design: We designed a prospective randomized controlled trial to study hemodynamic effects between Group I and Group II. Fifty patients were randomly allocated equally into Group I (GA + caudal epidural) and Group II (GA + intravenous analgesia) by sealed envelope technique. Subjects and Methods: After obtaining approval from Institutional Ethical Committee, this prospective study was conducted in 50 American Society of Anesthesiologist Classes II and III pediatric patients aged between 1 and 12 years posted for cardiac surgery in our institution. Statistical Analysis: ANOVA, two-way ANOVA, and Student's test. Results: The heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure variations were compared between Groups I and II at different time intervals. The variations were found to be significantly higher at the time of skin incision and 2 min after skin incision in Group II as compared to Group I. Pain score was compared between the groups and was found to be significantly lower with Group I (2.5 ± 1.2) as compared to Group II (4.6 ± 1.7), P = (0.004). Conclusions: Caudal analgesia with GA (Group I) was found to have better hemodynamic control and significantly better postoperative pain relief in the first 24 h after awakening.

Effect of addition of buprenorphine or dexamethasone to levobupivacaine on postoperative analgesia in ultrasound guided transversus abdominis plane block in patients undergoing unilateral inguinal hernia repair: a prospective randomized double blind controlled trial / 대한마취과학회지

BACKGROUND: The transversus abdominis plane (TAP) block is an effective technique to block the thoracolumbar nerves innervating the anterolateral abdominal wall. This study was conducted to evaluate the analgesic efficacy and opioid consumption with the use of perineural buprenorphine or dexamethasone in TAP blocks after unilateral inguinal hernioplasties. METHODS: This prospective, randomized, double-blinded, placebo-controlled study enrolled 93 patients scheduled for unilateral inguinal hernioplasty, followed by an ultrasound-guided TAP block. The participants were randomized into 3 groups (31 patients each). Group L received 20 ml 0.25% levobupivacaine + 1 ml normal saline (NS); group LB, 20 ml 0.25% levobupivacaine + 0.3 mg (1 ml) buprenorphine; and group LD, 20 ml 0.25% levobupivacaine + 4 mg (1 ml) dexamethasone. The patients were observed postoperatively for 24 h for first rescue analgesic requirement, total rescue analgesic consumption, and pain scores on the numeric rating scale (NRS). RESULTS: The time to first rescue analgesic requirement was significantly longer in Group LB than in groups LD and L (688.87 ± 36.11 min, 601.45 ± 39.85 min, and 383.06 ± 36.21 min, respectively; P < 0.001). The mean total tramadol consumption in the first 24 h was the lowest in group LB (P < 0.001, L vs. LB / LD). Groups LB and LD displayed significantly lower NRS scores than group L (P < 0.001 both). CONCLUSIONS: Levobupivacaine with perineural buprenorphine in a TAP block after unilateral open inguinal hernioplasty facilitates prolonged analgesia and reduced requirement for rescue analgesics compared to perineural dexamethasone, without significant side effects.

Comparison of the Clinical Outcomes of a Single Injection Adductor Canal Block with the Concomitant Use of Transdermal Buprenorphine and Continuous Adductor Canal Block after Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To compare the clinical outcomes of single injection adductor canal block (SACB), continuous adductor canal block (CACB), and the concomitant use of transdermal buprenorphine after total knee arthroplasty (TKA). MATERIALS AND METHODS: A total of 125 patients who underwent TKA were divided into three groups and the clinical results were retrospecitively compared. Group I was comprised of patients with pain controlled by SACB (n=41). Group II consisted of patients with pain controlled by both SACB and transdermal buprenorphine (10 µg/h) (n=44). Group III contained patients with pain controlled by CACB (n=40). The visual analogue scale (VAS) was used as the pain control indicator and the patients were measured on a VAS for resting on the bed (VAS-Rest) at 12 hours, 24 hours, and 48 hours after surgery. The VAS while doing continuous passive motion (VAS-CPM) on the first and second postoperative day was also measured. In addition, the total amount of medications used (Butopahn, Tridol, and Ketorac) for the intravenous patient controlled analgesia (PCA) was counted for 48 hours after surgery. As the indicator of the functional recovery outcome, the incidence of nausea and vomiting was observed for 48 hours after surgery. The maximum knee joint flexion range and maximum walking distance on the first and second postoperative day, and the total length of stay at the hospital were compared. RESULTS: The VAS-Rest was similar in the three groups at 12 hours after surgery, but at 24 hours and 48 hours after surgery, group II and III a lower VAS-CPM and total amount of medications used for PCA than group I (p<0.05). The three groups showed a low incidence of nausea and vomiting, maximum knee joint flexion range, and similar walking distance and total length of stay at the hospital. CONCLUSION: The combination of SACB and transdermal buprenorphine has great pain control effect initially. On the other hand, it is not associated with catheter complications and it is convenient to use and safety toward the renal function. Therefore, the concomitant use of SACB and transdermal buprenorphine can be an effective pain control method after TKA.

A comparative study between the efficacy of fentanyl with bupivacaine 05% and buprenorphine with bupivacaine 05% for lower abdominal and lower limb surgeries in a Government Tertiary Care Teaching Hospital

Background: Pain is one of the most common and uncomfortable consequences of surgery, feared by all. Effective and rapid relief from pain is always a challenge but is necessary for alleviating nocioception – induced responses like endocrine-metabolic responses to surgery, autonomic reflexes with adverse effects on organ function, reflexes leading to muscle spasm, and other undesirable results. Aim of the study: This study was done to compare the efficacy of intrathecal fentanyl with bupivacaine and buprenorphine with bupivacaine for all lower abdominal and lower limb surgeries. Materials and methods: Totally 60 ASA I and II patients of both sexes for different lower abdominal and lower limb surgeries were chosen for the study and the patients were divided into two groups of 30 patients in each group. Group F received 3 ml of 0.5% hyperbaric bupivacaine with 25 mcg fentanyl and group B received 3 ml of 0.5% hyperbaric bupivacaine with 75 mcg of buprenorphine. In our study, the time taken to achieve T10 level of the sensory blockade was considered as the time of V. Muruganantham, Nalini, Naheed Azar. A comparative study between the efficacy of fentanyl with bupivacaine 0.5% and buprenorphine with bupivacaine 0.5% for lower abdominal and lower limb surgeries in a Government Tertiary Care Teaching Hospital. IAIM, 2019; 6(5): 80-86. Page 81 onset of sensory block tested with pinprick method, motor block assessed by the onset of Bromage scale 3 and it was found that onset of the sensory block with bupivacaine + Fentanyl was earlier than compared with bupivacaine + Buprenorphine. Results: In the postoperative period VAS scores were significantly low for the buprenorphine group (Group B) when compared with fentanyl group (Group F). Conclusion: To summarize buprenorphine has higher efficacy with intrathecal bupivacaine, prolonged duration of postoperative analgesia and also analgesic-sparing effect in the post-operative period when compared to fentanyl.

Buprenorphine for Intractable Pain of Skin Ulcer Associated with Calcific Uremic Arteriolopathy (Calciphylaxis): A Case Report

Purpose: To describe a patient receiving maintenance hemodialysis complicated with calcific uremic arteriolopathy (calciphylaxis) in whom ulcer pain control was successfully achieved by buprenorphine. Case: A 75-year-old man was admitted due to intractable, extreme pain, which was accompanied by skin ulcers of the lower extremities. By a series of examinations including skin biopsy, the lesion was diagnosed to be calcific uremic arteriolopathy. The pain was not controllable with non-steroidal anti-inflammatory drugs and even by the nerve block. Buprenorphine, a partial agonist for the opioid receptor, markedly alleviated the mixed pain which was attenuated from Numerical Rating Scale (NRS) 10/10 to 0-2/10. Conclusion: Buprenorphine was very effective for the refractory pain control in a patient with skin ulcer due to calcific uremic arteriolopathy.

Successful Treatment with Transdermal Buprenorphine Patch in Opioid-Dependent Cancer Patients: Case Series / 한국호스피스완화의료학회지

Opioid aberrant behavior is an emerging problem as strong opioid is increasingly used to alleviate cancer pain in patients with cancer. Although the treatment of opioid addiction and physical dependence for non-cancer pain is well known, few studies have been conducted with cancer patients, particularly in the Korean population. Presented here are ten cases of cancer patients who were physically dependent on strong opioid and successfully treated with a partial mu-opioid receptor agonist, buprenorphine. This is the first report showing the efficacy of transdermal buprenorphine as a treatment for physical dependence on opioid medication in cancer patients.

Efectividad del cambio de tratamiento desde Metadona a Buprenorfina/Naloxona en dependientes a opiáceos, Bilbao - España / Effectiveness of treatment change from methadone to Buprenorphine / Naloxone in opiate dependents, Bilbao - Spain

A nivel mundial la dependencia a opiáceos es un problema vigente, y los pacientes afectados por esta condición requieren programas de tratamiento sustitutivo farmacológico, que utilizan tradicionalmente Metadona. Actualmente, existe debate sobre el hecho de que la Buprenorfina/Naloxona podria ser utilizada como un reemplazo adecuado del fármaco tradicional. Las investigaciones aún no son totalmente concluyentes, faltando estudios que prueben los resultados en la práctica clínica. Objetivos: Determinar la efectividad del tratamiento con Buprenorfina/Naloxona como reemplazo de la metadona en pacientes dependientes de opiáceos tratados en un Módulo de Asistencia Psicosocial en la ciudad de Bilbao, España. Métodos: Se realizó un estudio cuasiexperimental, cuantitativo, longitudinal, prospectivo, con 21 pacientes dependientes de opiáceos que formaban parte del Programa de mantenimiento con Metadona con dosis inferiores o iguales a 40 mg/día, en quienes se sustituyó ese tratamiento por el de Buprenorfina/Naloxona (8mg/2mg) siguiendo para esto los criterios de la Guía para el tratamiento de la adicción a opiáceos con Buprenorfina/Naloxona de la Sociedad Científica Española de estudios sobre alcohol, el alcoholismo y otras toxicomanías del 2010. Resultados: Después de tres meses de cambio de terapéutica a Buprenorfina/Naloxona se evidencio una reducción estadísticamente significativa en el consumo de opiáceos ilegales, medido a través de los controles de substancias en orina desde un promedio de 2,67 controles positivos con metadona, a 2,24 controles con Buprenorfina/Naloxona. La adherencia, se mantuvo similar a la previa, presentando además una retención del 100% de los pacientes. La calidad de vida, medida con el Test TECVASP, presento una mejora estadísticamente significativa, desde una puntuación de 76,76 cuando recibían Metadona (DE 6,41) hasta 90,33 (DE 5,77 ) con la nueva terapéutica. Conclusiones: Cambiar la terapia de mantenimiento con Metadona, en pacientes dependientes de opioides, por buprenorfina/naloxona es una buena opción, ya que tiene una efectividad similar en términos de adherencia y retención, y produce una mayor reducción en el uso de opiáceos ilegales, al tiempo que mejora la calidad de vida del paciente.

At the global level, opioid dependence is an ongoing problem, and patients with this condition require pharmacological substitution treatment programs, which traditionally use methadone. Currently there is debate over whether Buprenorphine / Naloxone could be used as a suitable replacement for the traditional drug. The investigations are not yet totally conclusive, lacking studies that prove the results in the clinical practice. Objectives: To determine the effectiveness of treatment with Buprenorphine / Naloxone as a replacement for Methadone in opioid dependent patients treated in a Psychosocial Assistance Module in the city of Bilbao, Spain. Methods: A quasi-experimental, quantitative, longitudinal, prospective study was conducted with 21 opioid-dependent patients that were part of the maintenance program with Methadone at doses lower than or equal to 40 mg / day, in which treatment was replaced by that of Buprenorphine / Naloxone (8 mg/2 mg) following for this the criteria of the Guide for the treatment of the addiction to opiates with Buprenorphine / Naloxone of the Spanish Scientific Society of studies on alcohol, alcoholism and other drug addictions of 2010. Results: After a three-month change in therapy to Buprenorphine / Naloxone, a statistically significant reduction in illegal opioid use was observed, measured through urine substance controls from an average of 2.67 methadone-positive controls 2.24 controls with Buprenorphine / Naloxone. The Adherence remained similar to the previous one, presenting a retention of 100% of the patients. Quality of life, measured with the TECVASP test, showed a statistically significant improvement, from a score of 76.76 when receiving Methadone (DE 6.41) to 90.33 (DE 5.77) with the new therapy. Conclusions: Changing maintenance therapy with methadone, in opioid-dependent patients, by buprenorphine/naloxone is a good option, because it has a similar effectiveness in terms of adherence and retention, and produces a greater reduction in the use of illegal opiates, and the same time improves the quality of life of the patient.

The efficacy of buprenorphine combined with joint mobilization in treating periarthritis of the shoulder / 中华物理医学与康复杂志

Objective To observe the clinical efficacy of combining buprenorphine with joint mobilization in the treatmeut of periarthritis of the shoulder.Methods A total of 103 patients were randomly divided into groups A,B and C.Group A received buprenorphine and joint mobilization;group B was treated with the non-steroidal antiinflammatory drug loxoprofen sodium and joint mobilization;group C received only joint mobilization.One week,3 weeks and three months after the treatment,the subjects used a visual analogue scale (VAS) to rate their level of discomfort,and Constant-Murley scores (CMS) and the degree of shoulder activity were quantified in all 3 groups.Any differences in the intensity of joint mobilization were also observed.Results The VAS ratings,CMS and the degree of activity of the shoulder joint improved significantly in all three groups after the treatment.One week after the treatment,the average VAS score of group A (2.8±1) was significantly lower than that of groups B (3.8±1) and C (4.5± 1.3),but group A's average CMS (60.1±10.7) had increased to significantly more than those of groups B (48.8± 11.0) and C (44.9±9.7).At the same time,the average shoulder joint rear protraction,90° extorsion abduction,internal rotation and external rotation angles of group A were all significantly bigger than those of groups B and C.The differences were maintained until at least three months after the treatment.One week after the treatment,the intensity of the joint mnobilization of group A was significantly higher than in groups B and C,with that discrepancy also continuing until at least 3 months after the treatment.Conclusions Buprenorphine combined with joint mobilization is very effective in the treatment of periarthritis of the shoulder.It is simple,safe and elicits good patient compliance.It is worthy of pronotion among shoulder periarthritis patients.

Buprenorphine fentanyl transdermal system combined gone.love Buna needle in artificial knee joint replacement long-acting analgesic effect / 中国生化药物杂志

Objective To study the transdermal buprenorphine Finland combined needle in patients in Buner after total knee arthroplasty long-acting analgesic effect. Methods 60 cases of total knee arthroplasty in Zhoushan Guang'an Hospital from February 2015 to August 2016 were selected as the study subjects, and were randomly divided into the control group and the experimental group, each group had 30 cases. The postoperative patients in control group were given Bouna needle, given buprenorphine finland transdermal patch on the basis of the experimental group. If the visual analogue scale of the two patients was greater than 5, tramadol hydrochloride sustained release tablets was given. The analgesic effects of the experimental group and the control group were compared and analyzed. Results After seventh days of treatment, the resting pain score of the experimental group was (1.11±0.43), significantly lower than that of the control group (2.50±0.68), with statistical significance (P<0.05). Seventh days after treatment, the daily dose of tramadol in the experimental group was (210.09±20.90) mg, significantly less than that of the control group (1123.90±60.90) mg, with statistical significance (P<0.05). There were no obvious adverse reactions in the two groups, and there was no significant difference. Conclusion The application of buprenorphine transdermal patches combined with finland gone.love Buna needle in artificial knee joint replacement surgery, the analgesic effect is obvious, can to some extent reduce the dosage of analgesic, side effects may still need to observe.

Buprenorphine fentanyl transdermal system combined gone.love Buna needle in artificial knee joint replacement long-acting analgesic effect / 中国生化药物杂志

Objective To study the transdermal buprenorphine Finland combined needle in patients in Buner after total knee arthroplasty long-acting analgesic effect. Methods 60 cases of total knee arthroplasty in Zhoushan Guang'an Hospital from February 2015 to August 2016 were selected as the study subjects, and were randomly divided into the control group and the experimental group, each group had 30 cases. The postoperative patients in control group were given Bouna needle, given buprenorphine finland transdermal patch on the basis of the experimental group. If the visual analogue scale of the two patients was greater than 5, tramadol hydrochloride sustained release tablets was given. The analgesic effects of the experimental group and the control group were compared and analyzed. Results After seventh days of treatment, the resting pain score of the experimental group was (1.11±0.43), significantly lower than that of the control group (2.50±0.68), with statistical significance (P<0.05). Seventh days after treatment, the daily dose of tramadol in the experimental group was (210.09±20.90) mg, significantly less than that of the control group (1123.90±60.90) mg, with statistical significance (P<0.05). There were no obvious adverse reactions in the two groups, and there was no significant difference. Conclusion The application of buprenorphine transdermal patches combined with finland gone.love Buna needle in artificial knee joint replacement surgery, the analgesic effect is obvious, can to some extent reduce the dosage of analgesic, side effects may still need to observe.