Buprenorphine analgesia following major abdominal surgery: a systematic review and meta-analysis

Ruan Vlok, Leigh White, Matthew Binks, Anthony Hodge, Thomas Ryan, Rachel Baran, Thomas Melhuish


Background: Opioid analgesia is commonly employed in the postoperative period. Opioids have a well-documented side effect profile. Their administration is made difficult following major abdominal surgery in those patients intolerant of oral intake. Furthermore, efforts are required to reduce the contribution of prescription opioids to the global illicit drug epidemic. Buprenorphine is thought to have a lesser side effect profile than morphine, is available in sublingual form and has a reduced risk of addiction. This study aims to compare the effectiveness and side effect profile of buprenorphine against morphine in managing pain following major abdominal surgery.
Methods: Five databases were searched up to May 2019. Randomized controlled trials comparing articles comparing buprenorphine with morphine post-major abdominal were included. Major abdominal surgery included operations on the abdominal wall, abdominal cavity or abdominal organs with an expected duration greater than 60 minutes. Postoperative pain and opioid-related adverse events, such as respiratory depression and sedation, were meta-analyzed.
Results: Eleven studies with a combined pool of 764 patients were included. Buprenorphine provided improved analgesia from 6 to 12 hours postoperatively (P=0.0003). Pain and analgesia use were otherwise equivalent with buprenorphine and morphine use up to 48 hours postoperatively. There was no discrepancy in respiratory depression, sedation, nausea, vomiting, dizziness or hypotension.
Conclusions: Buprenorphine is non-inferior to morphine in managing pain following major abdominal surgery. Opioid-related side effects were unaltered. Further study is required to analyse rates of addiction. The study was hindered by the number of relevant studies and the age of included data.