buprenorphine and Pain--Postoperative

The purpose of this study was to evaluate the safety and efficacy of buprenorphine compared with placebo in prolonging the duration of analgesia in single-injection peripheral nerve block. The systematic review and meta-analysis were conducted following the PRISMA statement and Review Manager was used for meta-analysis. Outcomes were calculated using the mean difference (MD) with 95% confidence interval (CI) for continuous data. For dichotomous outcomes, effect sizes were estimated by calculating pooled risk ratio (RR) with 95% CI. Statistical heterogeneity was estimated by the I

Topics: Analgesics, Opioid; Buprenorphine; Humans; Pain, Postoperative; Peripheral Nerves; Postoperative Nausea and Vomiting; Randomized Controlled Trials as Topic

The tissue damage and trauma associated with surgery almost always result in acute postoperative pain. The intensity of postoperative pain can range from mild to severe. Naltrexone is suitable for patients who do not wish to be on an agonist treatment such as methadone or buprenorphine. However, naltrexone has been shown to complicate postoperative pain management.. Multiple studies have found that the use of naltrexone can increase the opioid requirement for postoperative pain control. Other modalities exist that can help outside of opioids such as ketamine, lidocaine/bupivacaine, duloxetine, and non-pharmacological management can help manage pain. Multimodal pain regiments should also be employed in patients. In addition to traditional methods for postoperative pain management, other methods of acute pain control exist that can help mitigate opioid dependence and help control pain in patients who use naltrexone for their substance use disorders.

Topics: Acute Pain; Analgesics, Opioid; Buprenorphine; Humans; Methadone; Naltrexone; Opiate Substitution Treatment; Opioid-Related Disorders; Pain, Postoperative

Buprenorphine formulations (including buprenorphine/naloxone) are effective treatments of pain and opioid use disorder (OUD). Historically, perioperative management of patients prescribed buprenorphine involved abstinence from buprenorphine sufficient to allow for unrestricted mu-opioid receptor availability to full agonist opioid (FAO) treatment. Evidence is mounting that a multimodal analgesic strategy, including simultaneous administration of buprenorphine and FAO, nonopioid adjuncts such as acetaminophen and nonsteroidal anti-inflammatory drugs, and regional anesthesia, is a safe and effective perioperative strategy for the patient prescribed long-term buprenorphine treatment of OUD. This strategy will likely simplify management and more seamlessly provide continuous buprenorphine treatment of OUD after hospital discharge.

Topics: Acetaminophen; Aged; Analgesics, Non-Narcotic; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Arthroplasty, Replacement, Hip; Buprenorphine; Combined Modality Therapy; Drug Compounding; Female; Humans; Interdisciplinary Communication; Male; Opiate Substitution Treatment; Opioid-Related Disorders; Pain; Pain Management; Pain, Postoperative; Perioperative Care; Receptors, Opioid, mu

To review the pharmacology of buprenorphine, the evolution of buprenorphine dosing recommendations, and the current literature regarding its recommendations for the perioperative period.. There is a consensus that for all surgeries, buprenorphine should be continued throughout the perioperative period. If the surgery is a minimal to mild pain surgery, no dose adjustment is needed. There is no clear consensus regarding moderate to severe pain. With all surgeries, multimodal analgesia should be utilized, with regional anesthesia when possible. Patients taking buprenorphine should continue their buprenorphine perioperatively; whether to decrease or maintain dosing is up for debate. Multimodal analgesia should also be used throughout the perioperative period, and communication between the patient and all provider teams is of the utmost importance to provide adequate analgesia during the perioperative period, as well as to arrange safe analgesia upon discharge.

Topics: Analgesia; Analgesics, Opioid; Buprenorphine; Humans; Pain; Pain Management; Pain, Postoperative

The use of buprenorphine, a mixed opioid agonist-antagonist, for the management of chronic pain and/or opioid use disorder is increasing. As such, medical providers will more frequently encounter patients on this therapy. In this paper, we synthesize existing knowledge (derived through keyword searches using MEDLINE databases) in a novel conceptual framework for patients on buprenorphine presenting with acute pain or for those requiring surgical or invasive procedures. This framework is based on three unique domains: the patient, the features of the acute pain insult, and the environment. We discuss important considerations regarding the unique aspects of buprenorphine formulations and dosing, and we describe the importance of multidisciplinary planning and multimodal analgesic strategies. We also highlight important differences in management strategies based upon the presence or absence of opioid use disorder. All medical providers must be prepared to guide the patient on buprenorphine safely through the acute care episode, which includes adequate treatment of acute pain and avoidance of iatrogenic harm, including both short-term complications (eg, respiratory depression) and long-term complications (eg, relapse to opioid use).

Topics: Acute Pain; Buprenorphine; Dose-Response Relationship, Drug; Female; Humans; Male; Narcotic Antagonists; Opiate Substitution Treatment; Opioid-Related Disorders; Pain, Postoperative

Acute pain management in patients on buprenorphine opioid agonist therapy (BOAT) can be challenging. It is unclear whether BOAT should be continued or interrupted for optimization of postoperative pain control.. To determine an evidence-based approach for pain management in patients on BOAT in the perioperative setting, particularly whether BOAT should be continued or interrupted with or without bridging to another mu opioid agonist and to identify benefits and harms of either perioperative strategy.. Systematic literature review with qualitative data synthesis.. Hospital, perioperative.. The study protocol was registered on PROSPERO (Registration number 9030276355). Medline via OVID, EMBASE, CINAHL, and the Cochrane CENTRAL register of trials were searched for prospective or retrospective observational or controlled studies, case series, and case reports that described perioperative or acute pain care for patients on BOAT. References of narrative and systematic reviews addressing acute pain management in patients on BOAT and references of included articles were hand-searched to identify additional original articles for inclusion. The full text of publications were reviewed for final inclusion, and data were extracted using a standardized data extraction form. Results were summarized qualitatively. Primary outcomes were postoperative pain intensity and total opioid use and identification of benefits and harms of perioperative strategies.. Eighteen publications presenting data on the perioperative management of patients on BOAT were identified: 10 case reports, 5 case series, and 3 retrospective cohort studies. Eleven articles reported continuation of BOAT, 2 concerned bridging BOAT, and 4 articles described stopping BOAT without planned bridging. In one retrospective cohort study, BOAT was continued in half and interrupted in half of patients. Patients on BOAT may have pain that is more difficult to treat than those who are not on OAT. There is no clear evidence that one particular strategy provides superior postoperative pain control, but interruption of BOAT may result in harm, including failure to return to baseline BOAT doses, continuing non-BOAT opioid use, or relapse of opioid use disorder.. There were a limited number of articles relevant to the study question consisting of case reports and retrospective observational studies. Some omitted relevant details. No prospective studies were found.. There is no clear benefit to bridging or stopping BOAT but failure to restart it may pose concerns for relapse. We recommend continuing BOAT in the perioperative period when possible and incorporating an interdisciplinary approach with multimodal analgesia.. Opioid use disorder, opiate substitution treatment, buprenorphine, buprenorphine-naloxone, buprenorphine opioid agonist therapy, postoperative pain, acute pain, multimodal analgesia.

Topics: Analgesics, Opioid; Buprenorphine; Drug Administration Schedule; Humans; Observational Studies as Topic; Opiate Substitution Treatment; Opioid-Related Disorders; Pain Management; Pain, Postoperative; Prospective Studies; Retrospective Studies

There is no consensus on the optimal perioperative management of patients on buprenorphine (BUP) for opioid use disorder (OUD). This article will review the available literature on BUP and the analgesic efficacy of BUP combined with full mu-opioid agonists and discuss the conflicting management strategies in the context of acute pain and our institution's protocol for the periprocedural management of BUP.. We searched published data on BUP periprocedural management from inception through March 2018 without language restrictions. Study selection included publications reporting outcomes on perioperative pain management in OUD patients maintained on BUP.. Our search resulted in four case reports supporting periprocedural discontinuation of BUP and two case series, one secondary observational study, one prospective matched cohort study, and four retrospective cohort studies supporting periprocedural continuation of BUP. No clinical trials were identified.. Maintaining BUP perioperatively does not lead to worsened clinical outcomes. Patients can receive adequate pain control from mu-opioid agonists while maintained on BUP. Based upon available evidence, we recommend continuing BUP at a reduced dose when indicated to avoid withdrawal symptoms and to facilitate the analgesic efficacy of mu-opioid agonists administered in combination for acute postoperative pain.

Topics: Buprenorphine; Humans; Narcotic Antagonists; Opiate Substitution Treatment; Opioid-Related Disorders; Pain Management; Pain, Postoperative

The opioid crisis has reached an unprecedented magnitude in the United States and worldwide, and data on opioid use and misuse in the obstetric population are extremely concerning. Despite an abundant number of studies evaluating strategies to prevent neonatal opioid withdrawal syndrome in babies born to mothers who are chronic opioid users, in babies born to mothers using chronic opioids, numerous questions remain unanswered, including (1) how to optimally manage postpartum pain in opioid-dependent patients (2) how to reconcile buprenorphine and methadone use with intrapartum and post-partum analgesia, so as to avoid opioid withdrawal during and after delivery (3) how to safely and effectively provide a stepwise multimodal approach that incorporates systemic opioid-sparing approaches, such as neuraxial opioids, clonidine, ketamine, gabapentin, and regional anesthetic blocks, to ensure adequate pain relief while avoiding opioid withdrawal (4) how to optimally manage post-partum recovery and (5) how to avoid excessive opioid prescription and possibly leftover opioids that may promote persistent use, misuse and diversion. With the recognition that an increasing number of pregnant women are taking chronic opioids, the goals of this review article are to summarize the existing literature on post-cesarean pain management in the obstetric patient with an opioid-use disorder; and to provide clinicians with a stepwise approach for management before, as well as during and after, cesarean delivery of women who have been chronically using opioids during their pregnancy.

Topics: Analgesia, Patient-Controlled; Buprenorphine; Cesarean Section; Female; Humans; Methadone; Naltrexone; Opioid-Related Disorders; Pain, Postoperative; Pregnancy; Pregnancy Complications

Et stadig høyere antall pasienter i legemiddelassistert rehabilitering dør av somatiske sykdommer, inkludert kreftsykdom. I det palliative sykdomsforløpet er særlig smertebehandlingen utfordrende.

Topics: Acetaminophen; Analgesics, Non-Narcotic; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Cancer Pain; Humans; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders; Pain Management; Pain Measurement; Pain, Postoperative; Palliative Care; Terminal Care

The duration of analgesia provided by nerve blocks is limited if local anaesthetics are administered alone. Therefore, a variety of additives to local anaesthetics have been investigated to prolong postoperative analgesia following single-shot nerve blocks.. The aims of the current meta-analysis were to assess the efficacy and safety of the addition of perineural buprenorphine to local anaesthetic compared with local anaesthetic alone, or combined with systemic administration of buprenorphine, or other perineural opioids for peripheral nerve blocks.. Systematic review and meta-analysis of randomised controlled trials (RCTs).. The following data sources were systematically searched: MEDLINE, CENTRAL and EMBASE (till 03/2016).. All RCTs focusing on the efficacy and safety of perineural buprenorphine combined with local anaesthetic compared with local anaesthetic alone, or in combination with systemic buprenorphine, or other perineural opioids for peripheral nerve blocks were included.. We included 13 RCTs (685 patients). Participants treated with perineural buprenorphine combined with local anaesthetic showed a longer duration of analgesia compared with those receiving local anaesthetic alone [mean difference 8.64 h, 95% confidence interval (CI) (6.44 to 10.85); P < 0.01]. However, the buprenorphine group had a significantly higher relative risk (RR) for postoperative nausea and vomiting (PONV) [RR 5.0, 95% CI (1.12 to 22.27); P = 0.03]. The perineural administration of buprenorphine provided a longer duration of analgesia than an intramuscular application [mean difference 6.87 h, 95% CI (4.02 to 9.71); P < 0.01] without evidence of a difference in the incidence of PONV between the modes of administration [RR 0.76, 95% CI (0.28 to 2.03); P = 0.58].. This meta-analysis revealed that the addition of buprenorphine to a local anaesthetic peripheral nerve block prolongs postoperative analgesia for about 8 h but significantly increases the risk for PONV. Perineural administration is more effective than systemic application but is associated with a similar risk of PONV. However, these results were influenced by heterogeneity so that further trials (especially head-to-head comparisons) are needed in the future.. PROSPERO(www.crd.york.ac.uk) identifier: CRD42016036054.

Topics: Analgesics, Opioid; Anesthetics, Local; Buprenorphine; Humans; Incidence; Injections, Intramuscular; Nerve Block; Pain, Postoperative; Peripheral Nerves; Postoperative Nausea and Vomiting; Randomized Controlled Trials as Topic; Surgical Procedures, Operative; Time Factors; Treatment Outcome

Perioperative management of patients receiving opioid addiction therapy presents a unique challenge for the anesthesiologist. The goal of pain management in this patient population is to effectively manage postoperative pain, to improve patient satisfaction and outcomes, and to reduce the cost of health care. Multimodal analgesics, including nonsteroid anti-inflammatory drugs, intravenous acetaminophen, gabapentanoid agents, and low-dose ketamine infusions, have been used to improve postoperative pain and to reduce postoperative opioid use. Patients on long-term opioid management therapy with methadone and buprenorphine require special considerations. Recommendations and options for treating postoperative pain in patients on methadone and buprenorphine are outlined below. Other postoperative pain management options include patient-controlled analgesia, intravenous, and transdermal, in addition to neuraxial and regional anesthesia techniques. Special patient populations include the parturient on long-term opioid therapy. Recommendations for use of opioids in these patients during labor and delivery and in the postpartum period are discussed.

Topics: Buprenorphine; Drug Administration Schedule; Female; Humans; Methadone; Neonatal Abstinence Syndrome; Opiate Substitution Treatment; Opioid-Related Disorders; Pain Management; Pain, Postoperative; Postpartum Period; Practice Guidelines as Topic; Pregnancy; Pregnancy Outcome

Preoperative evaluation of patients with chronic pain is important because it may lead to multidisciplinary preoperative treatment of patients' pain and a multimodal analgesia plan for effective pain control. Preoperative multidisciplinary management of chronic pain and comorbid conditions, such as depression, anxiety, deconditioning, and opioid tolerance, can improve patient satisfaction and surgical recovery. Multimodal analgesia using pharmacologic and nonpharmacologic strategies shifts the burden of analgesia away from simply increasing opioid dosing. In more complicated chronic pain patients, multidisciplinary treatment, including pain psychology, physical therapy, judicious medication management, and minimally invasive interventions by pain specialists, can improve patients' satisfaction and surgical outcome.

Topics: Analgesia; Analgesics, Opioid; Buprenorphine; Chronic Pain; Humans; Opioid-Related Disorders; Pain Measurement; Pain, Postoperative; Perioperative Period; Preoperative Care

Buprenorphine is a long-acting opiate with a high therapeutic index. The authors review the pharmacology, toxicity, analgesic effects and delivery of buprenorphine for use in laboratory mice and rats. Buprenorphine-based analgesic therapy has a substantial record of safety, and there is growing evidence of its effectiveness for treating post-operative pain. Nonetheless, more research is needed to determine optimal delivery systems and analgesic regimens for pain therapy in laboratory animals.

Topics: Analgesia; Analgesics, Opioid; Animals; Buprenorphine; Mice; Pain, Postoperative; Rats

The transdermal therapeutic system (TTS) with buprenorphine is currently being used 'off-label' to treat chronic pediatric pain. We compiled available pharmacokinetic (PK), pharmacodynamic (PD), and clinical pediatric data on buprenorphine to rationalize treatment regimens.. We conducted a systematic biomedical literature review focusing on pediatric buprenorphine data.. There are few relevant pediatric buprenorphine data, particularly in children suffering chronic pain. There are no pediatric PK and PD data for children with chronic pain given sublingual or TTS formulations. Children given single dose buprenorphine have increased drug clearance referenced to bodyweight with a possible paradoxical longer duration of action. Buprenorphine metabolism is independent of renal function, which is advantageous in renal insufficiency. The risk of respiratory depression after buprenorphine is difficult to quantify. A concentration-response relationship for respiratory effects has not been described and it is unknown whether children have a ceiling effect similar to that described in healthy adult volunteers.. Buprenorphine is of interest in pediatric postoperative pain and cancer pain control because of its multiple administration routes, long duration of action, and metabolism largely independent of renal function. There is little reason to expect buprenorphine effects in children out of infancy are fundamentally different to those in adults. From the limited pediatric data available, it appears that buprenorphine has no higher adverse potential than the more commonly used opioids. There is an urgent need for focused PK, PD, and safety studies in children before use in children becomes more widespread.

Topics: Administration, Cutaneous; Adolescent; Adult; Analgesics, Opioid; Buprenorphine; Child; Drug Delivery Systems; Drug Eruptions; Female; Humans; Male; Pain; Pain, Postoperative; Receptors, Opioid, mu; Respiratory Insufficiency; Substance Withdrawal Syndrome; Young Adult

Topics: Buprenorphine; Child; Female; Fetus; Humans; Narcotic Antagonists; Opioid-Related Disorders; Pain, Postoperative; Pregnancy

In Australia and New Zealand, in parallel with other developed countries, the number of patients prescribed opioids on a long-term basis has grown rapidly over the last decade. The burden of chronic pain is more widely recognised and there has been an increase in the use of opioids for both cancer and non-cancer indications. While the prevalence of illicit opioid use has remained relatively stable, the diversion and abuse of prescription opioids has escalated, as has the number of individuals receiving methadone or buprenorphine pharmacotherapy for opioid addiction. As a result, the proportion of opioid-tolerant patients requiring acute pain management has increased, often presenting clinicians with greater challenges than those faced when treating the opioid-naïve. Treatment aims include effective relief of acute pain, prevention of drug withdrawal, assistance with any related social, psychiatric and behavioural issues, and ensuring continuity of long-term care. Pharmacological approaches incorporate the continuation of usual medications (or equivalent), short-term use of sometimes much higher than average doses of additional opioid, and prescription of non-opioid and adjuvant drugs, aiming to improve pain relief and attenuate opioid tolerance and/or opioid-induced hyperalgesia. Discharge planning should commence at an early stage and may involve the use of a 'Reverse Pain Ladder' aiming to limit duration of additional opioid use. Legislative requirements may restrict which drugs can be prescribed at the time of hospital discharge. At all stages, there should be appropriate and regular consultation and liaison with the patient, other treating teams and specialist services.

Topics: Acute Disease; Analgesics; Analgesics, Opioid; Animals; Australia; Buprenorphine; Buprenorphine, Naloxone Drug Combination; Drug Tolerance; Humans; Hyperalgesia; Illicit Drugs; Methadone; Naloxone; Narcotic Antagonists; Narcotics; New Zealand; Opiate Substitution Treatment; Opioid-Related Disorders; Pain; Pain, Postoperative; Patient Discharge; Preoperative Care; Substance Withdrawal Syndrome

Patients on drug-assisted rehabilitation have the same right to pain relief as others. Techniques that reduce the need for opioids should be used when possible in opioid-dependent individuals who need treatment of acute and post-operative pain. Substitution treatment should always be continued. In some situations a switch to a different opioid or route of administration is required. Higher doses of opioids than those needed in other patients may be required for analgesia. Well-designed clinical studies are lacking in this field.

Topics: Acetaminophen; Acute Disease; Analgesics, Non-Narcotic; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Glucocorticoids; Humans; Ketamine; Methadone; Opioid-Related Disorders; Pain; Pain, Postoperative; Surgical Procedures, Operative

Several decades ago, the analgesic properties of buprenorphine were discovered. Its approval for the use as an agent for the treatment of opioid abuse has led to increasing numbers of patients presenting for surgery on buprenorphine. This article describes the challenges, advantages, and disadvantages of the use of buprenorphine as an analgesic for postoperative pain in patients with and without preoperative maintenance therapy.

Topics: Acute Disease; Analgesics, Opioid; Buprenorphine; Chronic Disease; Humans; Pain, Postoperative; Receptors, Opioid

Topics: Analgesia, Epidural; Analgesia, Patient-Controlled; Analgesics, Opioid; Anesthetics, Local; Buprenorphine; Hematoma, Epidural, Spinal; Humans; Morphine; Nausea; Pain, Postoperative; Respiratory Insufficiency; Urination Disorders

Buprenorphine has been widely used for post-operative analgesia in laboratory animals. Clinical efficacy has been demonstrated in both subjective and objective pain assessment schemes, however doubts have been expressed as to its value as an analgesic. Initial dosage recommendations were based on analgesiometric studies. It is unlikely, however, that the pain elicited in analgesiometric tests is comparable to post-operative pain. This has resulted in recommendations of excessive dose rates and inappropriate clinical indications. Studies involving tests of the efficacy of buprenorphine for alleviating behavioural or other signs of tonic (post-surgical) pain provide a more appropriate estimation of the analgesic capabilities of the drug. However, buprenorphine also has major effects upon the behaviour of normal (unoperated) animals, and this makes assessments of efficacy difficult with some of the systems used for scoring clinical pain. Nevertheless, our most recent studies of the effects of buprenorphine upon pain-related behaviours in rats support the view that it is an effective post-operative analgesic. This short review critically reappraises the role of buprenorphine in this capacity and discusses a rational approach to the relief of pain in laboratory animals. We conclude that buprenorphine remains a valuable agent for pain relief in a wide range of animal species when used in an appropriate manner.

Topics: Analgesics, Opioid; Animals; Animals, Laboratory; Buprenorphine; Dose-Response Relationship, Drug; Humans; Pain Measurement; Pain, Postoperative; Species Specificity; Treatment Outcome

The clinical use of the patient-controlled analgesia (PCA) represents a further improvement in the treatment of post-operative pain. In this way in success due to inadequate protocols, unpredictability of the drug absorption and variability of the response to one drug or to the same pain patterns between patients can be avoided. This technique allows the patient himself to control the pain without depending upon nurses or physicians for the administration of analgesic drugs. Although the PCA is in use since several years, there are still some unresolved problems which are considered in this paper.

Topics: Analgesia, Patient-Controlled; Analgesics, Opioid; Anesthetics, Intravenous; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Clinical Trials as Topic; Fentanyl; Humans; Infusions, Intravenous; Meperidine; Meta-Analysis as Topic; Morphine; Pain, Postoperative; Patient Compliance; Tramadol

Extended-release (ER) local anesthetics can be used in multi-modal analgesia or in situations in which systemic analgesics may alter animal physiology and thus introduce interpretational confounds. In this study, we compared the analgesic efficacy of an ER buprenorphine formulation with that of a synergistic combination of ER bupivacaine and meloxicam. Female and male CD1 mice were randomly assigned to receive subcutaneous buprenorphine (3.25mg/kg) preemptively, subcutaneous infiltration of bupivacaine???meloxicam (0.03mL at incision closure (bupivacaine, 35mg/kg; meloxicam, 1mg/kg), or saline (10mL/kg SC) after induction of anesthesia. After laparotomy, mice were assessed for changes in daily body weight, rearing frequency, nest consolidation scores, time-to-integrate-nest test (TINT), and response to von Frey testing at 4, 8, 24, 48, and 72h after surgery. Daily weight, nest consolidation scores and rearing frequency were not significantly different among the 3 groups. TINT had fallen significantly response at 24 and 48h after injection in the ER buprenorphine group as compared with the saline and ER bupivacaine-meloxicam groups. Nociceptive thresholds, as assessed with von Frey testing, differed between saline controls and both analgesic groups at 4, 8, 24, 48, and 72 h after surgery. None of the mice in the bupivacaine???meloxicam group developed signs of neurotoxicity, a potential side effect of high-dose local anesthetics. This study demonstrates that local ER bupivacaine???meloxicam may be a useful alternative to systemic, ER buprenorphine for the relief of pain after laparotomy in mice.

Topics: Analgesics; Analgesics, Opioid; Anesthetics, Local; Animals; Bupivacaine; Buprenorphine; Female; Laparotomy; Male; Meloxicam; Mice; Pain; Pain, Postoperative; Rodent Diseases

Intraperitoneal administration of local anaesthetics may reduce postoperative pain after ovariohysterectomy in dogs. The aim of this prospective, randomised, blinded, placebo-controlled clinical trial was to compare postoperative analgesia and opioid requirements after intraperitoneal and incisional administration of ropivacaine versus 0,9 % NaCl (saline). Forty-three client-owned dogs were enrolled in the study and anaesthetised using a standardized protocol that included premedication with acepromazine (0,03-0,05 mg/kg) and dexmedetomidine (0,01 mg/kg) intramuscularly. Anaesthesia was induced with propofol titrated to effect and ketamine (1 mg/kg) intravenously and maintained with isoflurane in oxygen. The analgesic regimen included carprofen (4 mg/kg) subcutaneously and morphine (0,2 mg/kg) intravenously. Depending on group assignment, each dog received either an intraperitoneal and incisional splash with ropivacaine (2 mg/kg and 1 mg/kg, respectively) (group R), or an equal volume of saline (group S). Buprenorphine (0,02 mg/kg) was administered intramuscularly once the uterus was removed. Sedation and pain were assessed 0,5, 1, 2, 4, 6 and 8 hours after extubation using a sedation scale, the short form of the Glasgow Composite Pain Scale (CMPS-SF) and a dynamic interactive visual analogue scale (DIVAS). Postoperatively, buprenorphine (0,01 mg/kg) was administered intravenously if dogs scored 6/24 on CMPS-SF. The ordinal mixed model showed no difference in pain scores between groups. Fisher's exact test showed no significant difference in postoperative buprenorphine requirements between group S (3/22 dogs) and group R (1/21 dogs) at the doses used. In addition, lower sedation scores were associated with higher DIVAS scores. In this multimodal analgesic protocol, ropivacaine could not improve analgesia compared to saline.. Die intraperitoneale Verabreichung von Lokalanästhetika kann postoperativen Schmerzen nach einer Ovariohysterektomie bei Hunden lindern. Das Ziel dieser prospektiven, randomisierten, verblindeten, Placebo kontrollierten klinischen Studie war der Vergleich der postoperativen Analgesie und des Opioidbedarfs nach intraperitonealer und inzisionaler Verabreichung von Ropivacain im Vergleich zu 0,9 % NaCl (Kochsalzlösung). In die Studie wurden 43 Hunde aufgenommen und nach einem standardisierten Protokoll mittels intramuskuläre Prämedikation (0,03–0,05 mg/kg Acepromazin, 0,01 mg/kg Dexmedetomidin 0,01 mg/kg) und mit auf die Wirkung eingestelltem Propofol und Ketamin (1 mg/kg) intravenös eingeleitet, sowie die Anästhesie mit Isofluran in Sauerstoff aufrechterhalten. Das analgetische Regime umfasste Carprofen (4 mg/kg) subkutan und Morphin (0,2 mg/kg) intravenös. Abhängig von der Gruppenzuordnung erhielt jeder Hund entweder eine intraperitoneale und inzisionele Verabreichung von Ropivacain (2 mg/kg bzw. 1 mg/kg) (Gruppe R) oder eine gleiche Menge Kochsalzlösung (Gruppe S). Bei Entfernung der Gebärmutter wurde zusätzlich Buprenorphin (0,02 mg/kg) intramuskulär verabreicht. Sedierung und Schmerzen wurden 0,5, 1, 2, 4, 6 und 8 Stunden nach der Extubation anhand einer Sedierungsskala, der Kurzform der Glasgow Composite Pain Scale (CMPS-SF) und einer dynamischen interaktiven visuellen Analogskala (DIVAS) bewertet. Postoperativ wurde Buprenorphin (0,01 mg/kg) intravenös verabreicht, wenn die Hunde im CMPS-SF einen Wert von 6/24 erreichten. Das ordinale gemischte Modell zeigte keinen Unterschied in den Schmerzwerten zwischen den Gruppen. Der Exakte Fisher-Test zeigte bei den verwendeten Dosen keinen signifikanten Unterschied im postoperativen Buprenorphinbedarf zwischen Gruppe S (3/22 Hunde) und Gruppe R (1/21 Hunde). Darüber hinaus waren niedrigere Sedierungswerte mit höheren DIVAS-Werten verbunden. In diesem multimodalen Analgetikaprotokoll konnte Ropivacain die Analgesie im Vergleich zu Kochsalzlösung nicht verbessern.. L’administration intrapéritonéale d’anesthésiques locaux peut réduire la douleur postopératoire après une ovariohystérectomie chez la chienne. L’objectif de cet essai clinique prospectif, randomisé, en aveugle et contrôlé par placebo était de comparer l’analgésie postopératoire et les besoins en opioïdes après l’administration intrapéritonéale et incisionnelle de ropivacaïne par rapport à du NaCl 0,9 % (sérum physiologique). Quarante-trois chiennes appartenant à des clients ont été enrôlés dans l’étude et anesthésiés selon un protocole standardisé comprenant une prémédication par acépromazine (0,03 - 0,05 mg/kg) et dexmedetomidine (0,01 mg/kg) par voie intramusculaire. L’anesthésie a été induite avec du propofol dosé à l’effet et de la kétamine (1 mg/kg) par voie intraveineuse et maintenue avec de l’isoflurane dans de l’oxygène. Le traitement analgésique comprenait du carprofène (4 mg/kg) par voie sous-cutanée et de la morphine (0,2 mg/kg) par voie intraveineuse. En fonction de son affectation à un groupe, chaque chien a reçu soit une injection intrapéritonéale et incisionnelle de ropivacaïne (2 mg/kg et 1 mg/kg, respectivement) (groupe R), soit un volume égal de solution saline (groupe S). La buprénorphine (0,02 mg/kg) a été administrée par voie intramusculaire après l’ablation de l’utérus. La sédation et la douleur ont été évaluées 0,5, 1, 2, 4, 6 et 8 heures après l’extubation à l’aide d’une échelle de sédation, de la forme courte de l’échelle composite de douleur de Glasgow (CMPS-SF) et d’une échelle visuelle analogique interactive dynamique (DIVAS). En postopératoire, de la buprénorphine (0,01 mg/kg) a été administrée par voie intraveineuse si les chiens obtenaient un score de 6/24 sur l’échelle CMPS-SF. Le modèle mixte ordinal n’a montré aucune différence dans les scores de douleur entre les groupes. Le test exact de Fisher n’a pas montré de différence significative dans les besoins postopératoires en buprénorphine entre le groupe S (3/22 chiens) et le groupe R (1/21 chiens) aux doses utilisées. De plus, des scores de sédation plus faibles étaient associés à des scores DIVAS plus élevés. Dans ce protocole d’analgésie multimodale, la ropivacaïne n’a pas permis d’améliorer l’analgésie par rapport au sérum physiologique.. L’amministrazione intraperitoneale di anestetici locali potrebbe ridurre il dolore post-operatorio dopo una ovarioisterectomia nei cani. Lo scopo di questo studio clinico prospettico, randomizzato, in doppio cieco, controllato con placebo, era di mettere a confronto l’analgesia post-operatoria e il fabbisogno di oppioidi dopo l’amministrazione intraperitoneale e incisionale di ropivacaina rispetto allo 0,9% di NaCl (soluzione salina). Quarantatré cani sono stati arruolati nello studio e anestetizzati utilizzando un protocollo standardizzato che includeva la premedicazione con acepromazina (0,03 - 0,05 mg/kg) e dexmedetomidina (0,01 mg/kg) per via intramuscolare. L’anestesia è stata indotta con propofol titolato per effetto e ketamina (1 mg/kg) per via endovenosa e mantenuta con isoflurano in ossigeno. Il regime analgesico includeva carprofene (4 mg/kg) per via sottocutanea e morfina (0,2 mg/kg) per via endovenosa. A seconda dell’assegnazione al gruppo, ciascun cane ha ricevuto un’infusione intraperitoneale e incisionale di ropivacaina (rispettivamente 2 mg/kg e 1 mg/kg) (gruppo R), oppure un volume equivalente di soluzione salina (gruppo S). La buprenorfina (0,02 mg/kg) è stata somministrata per via intramuscolare una volta che l’utero è stato rimosso. Sedazione e dolore sono stati valutati 0,5, 1, 2, 4, 6 e 8 ore dopo l’estubazione utilizzando la scala di sedazione, la versione abbreviata della Glasgow Composite Pain Scale (CMPS-SF) e la scala visiva analogica interattiva dinamica (DIVAS). Dopo l’intervento, la buprenorfina (0,01 mg/kg) è stata somministrata per via endovenosa se i cani avevano un punteggio 6/24 sulla CMPS-SF. Il modello misto ordinale non ha mostrato differenze tra i punteggi del dolore tra i gruppi. Il test esatto di Fisher non ha mostrato differenze significative nel fabbisogno post-operatorio di buprenorfina tra il gruppo S (3/22 cani) e il gruppo R (1/21 cani) alle dosi utilizzate. Inoltre, punteggi di sedazione più bassi erano associati a punteggi più alti per la DIVAS. In questo protocollo di analgesia multimodale, la ropivacaina non è riuscita a migliorare l’analgesia rispetto alla soluzione salina.

Topics: Analgesia; Analgesics; Analgesics, Opioid; Anesthesia; Animals; Buprenorphine; Dog Diseases; Dogs; Female; Humans; Hysterectomy; Ovariectomy; Pain, Postoperative; Prospective Studies; Ropivacaine

To compare pain outcome reports of patients undergoing hip or knee replacement who received single-injection nerve/plexus blocks with plain bupivacaine (BPV) with those of patients who received injections of buprenorphine-clonidine-dexamethasone (BCD) admixed with BPV.. Prospective, parallel-arm, randomized, double-blind trial.. A single veterans' hospital.. Ninety-eight veterans scheduled for total hip or knee replacement surgery with spinal as the primary anesthetic.. Participants were randomized to BPV-BCD or plain BPV groups. They underwent nerve/plexus blocks in the L2-L4 and L4-S3 distributions in advance of joint replacement surgery. The primary outcome was change in pain from baseline during the postoperative day, as assessed by the total pain score on the short-form McGill Pain Questionnaire-v2 (SF-MPQ-2). Secondary outcomes were pain during movement, pain interference, range of motion, mobility, and quality of recovery.. On postoperative day one, the SF-MPQ-2 total score for the BPV-BCD group demonstrated greater pain reduction than that of the plain BPV group (mean difference 1.8 points, 95% confidence interval 0.6 to 3.0, P = 0.003). The BPV-BCD group also had larger reductions in pain during movement in the surgical joint and less pain interference, along with increased range of hip and knee flexion, compared with the plain BPV group. Outcomes of mobility and quality of recovery were not different between groups.. Preoperative BPV-BCD blocks in the L2-L4 and L4-S3 nerve distributions for hip and knee replacements led to less pain on postoperative day one and increased knee and hip range of motion, compared with plain BPV blocks.. ClinicalTrials.gov ID NCT02891798.

Topics: Anesthetics, Local; Bupivacaine; Buprenorphine; Clonidine; Dexamethasone; Double-Blind Method; Humans; Nerve Block; Pain, Postoperative; Prospective Studies

To compare the thermoregulatory and analgesic effects of high-dose buprenorphine versus morphine in cats undergoing ovariohysterectomy.. 94 client-owned cats.. Cats were randomized to receive either buprenorphine 0.24 mg/kg or morphine 0.1 mg/kg subcutaneously (SC) during recovery from ovariohysterectomy. Body temperature measurements were obtained before anesthesia, during anesthesia (averaged), at extubation, and 2, 4, and 16 to 20 hours postoperatively. Signs of pain were assessed, and demographic characteristics were compared between groups. The effects of treatment and time on body temperature, point prevalence of hyperthermia (> 39.2 °C), and pain scores were compared with linear or generalized mixed-effect models.. Cats receiving morphine (vs. buprenorphine) were older and heavier (both, P ≤ 0.005). Other group characteristics did not differ between treatments. Cats receiving buprenorphine (vs. morphine) had higher postoperative temperatures (P = 0.03). At 2, 4, and 16 to 20 hours after extubation, the point prevalence of hyperthermia was greater (P = 0.001) for cats receiving buprenorphine (55% [26/47], 44% [21/47], and 62% [27/43], respectively) versus morphine (28% [13/46], 13% [6/46], and 47% [21/44], respectively). There were no differences in pain scores between groups or over time. Five cats receiving buprenorphine and 6 receiving morphine required rescue analgesia within the 24-hour period.. Administration of buprenorphine (0.24 mg/kg SC), compared with morphine (0.1 mg/kg SC), resulted in higher body temperatures without an apparent advantage with regard to analgesia during the first 20 postoperative hours than morphine. Opioid-induced postoperative hyperthermia could confound the diagnosis of fever from different sources.

Topics: Analgesics, Opioid; Animals; Buprenorphine; Cat Diseases; Cats; Female; Hyperthermia, Induced; Hysterectomy; Morphine; Ovariectomy; Pain, Postoperative

A prospective, double-masked, placebo-controlled, multicentered phase 2 clinical study was conducted to select the transdermal buprenorphine solution (TBS) dosage for the control of postoperative pain in cats. One-hundred fifteen (115) cats were randomized to a single topical dose of placebo solution, low-TBS dosage (1.91-2.07 mg/kg) or high-TBS dosage (4.27-4.88 mg/kg) prior to surgical reproductive sterilization in conjunction with forelimb onychectomy. The low- and high-TBS doses were applied 2-4 and 1-2 hours prior to surgery. Interactive pain assessments and physiological variables were quantified through 96 hours post-anesthetic recovery and rescue analgesia was administered any time that analgesia was considered inadequate. Cats requiring rescue analgesia were considered treatment failures. The estimated overall treatment success rates from generalized linear mixed effects model analysis were 0.10 (95% CI: [0.02-0.36]), 0.56 (95% CI: [0.25-0.83]), 0.71 (95% CI: [0.38-0.91]) in the placebo-, low-, and high-TBS dose groups, respectively. Success rates for both TBS treatment groups were superior to placebo. Adverse events were infrequent in all treatment groups although the postoperative body temperatures over the duration of the study were on average 0.31 (95% CI: [0.08-0.55]) and 0.30 (95% CI: [0.05-0.53]) °C higher in low- and high-TBS dose cats, respectively, compared to placebo. It is concluded that both the low- and high-TBS dosages were safe and effective. The high-TBS dosage resulted in a greater proportion of treatment successes over 96 h, had a more acceptable preoperative application time of 1-2 h prior to surgery, and was therefore selected for further study.

Topics: Administration, Cutaneous; Analgesia; Analgesics, Opioid; Animals; Buprenorphine; Cat Diseases; Cats; Delayed-Action Preparations; Pain, Postoperative; Prospective Studies

A prospective, double masked, placebo-controlled, multicentered phase 3 clinical study was conducted to evaluate the safety and effectiveness of transdermal buprenorphine solution (TBS) for the control of post-operative pain in cats. A total of 228 cats from 12 US investigational sites met the enrollment criteria of which 107 placebo- and 112 TBS-treated cats were included into the per protocol efficacy analysis. The dose of TBS was 8 mg (0.4 ml) to cats 1.2 to 3 kilograms and 20 mg (1 ml) to cats >3 to 7.5 kilograms applied topically to the dorsal unclipped cervical skin 1-2 h prior to the undergoing elective surgical reproductive sterilization in conjunction with forelimb onychectomy. Interactive pain assessments and physiological variables were quantified through 96 h following recovery from anesthesia, and rescue analgesia was administered any time that pain control was scored inadequate. Cats requiring rescue analgesia or experiencing an adverse event suspected to be treatment related were considered treatment failures. Sixty-five and 23 cats were considered treatment failures in the placebo and TBS groups, respectively, with most occurring on the day of surgery. The treatment success rates were 0.40 (95% confidence interval [CI]: [0.28-0.53]) and 0.81 (95% CI: [0.70-0.89]) in the placebo and TBS groups, respectively, and the difference was significant (p < .05). Adverse events occurred at a similar frequency and were not clinically meaningful in either treatment group. The post-operative body temperatures over the duration of the study were on average 0.35 (95% CI: [0.20-0.50]) °C higher than baseline in TBS-treated cats and were not clinically meaningful, an observation typical of opioids in cats. These results serve as substantial evidence that TBS is safe and effective for the control of orthopedic and soft tissue post-operative pain in cats when a single topical dose is applied 1-2 h prior to surgery.

Topics: Administration, Cutaneous; Analgesia; Analgesics, Opioid; Animals; Buprenorphine; Cat Diseases; Cats; Delayed-Action Preparations; Pain, Postoperative; Prospective Studies

Transdermal buprenorphine solution (TBS) is approved for the control of postoperative pain in cats where a single preoperative dose provides 4 days of analgesia. It is administered as a unit dose of 8 mg to cats weighing 1.2-3 kg and 20 mg to cats weighing to >3-7.5 kg, which is equivalent to a dosage on a bodyweight basis of 2.7-6.7 mg/kg. In this safety study, the 1X dose was defined as 6.7 mg/kg. Thirty-two cats (16 males and 16 females) were randomly allocated to placebo, 1, 2, and 3X TBS administered topically to the dorsal cervical skin every 4 days for 3 doses. Clinical observations, behavioral scores, mydriasis score (yes/no), and physiological variables were assessed or measured prior to each dose administration (0 h) and at 1, 2, 4, 8, 12, 24, 36, 48, and 72 h following each treatment and prior to euthanasia on Day 12 or 13. Blood samples for clinical pathology were collected on Days - 1, 4, 8, and prior to euthanasia. There was little evidence of respiratory, cardiovascular, or gastrointestinal effects. Respiratory rates were above the reference range in all groups and lower by 10 breaths/min in the 3X group during the third dosing interval compared to placebo. There were no differences in heart rates. Constipation was transiently observed in approximately equal numbers in placebo- and TBS-treated cats. Behavioral scores showed sedation or euphoria was transient in the first dosing interval but became more prolonged with each dosing interval. Mydriasis was prolonged in the first dosing interval and diminished by the third dosing interval consistent with accommodation. Mean body temperatures in TBS-treated cats were up to 0.6°C (1.8°F) greater than placebo-treated cats. There were no clinically relevant changes to serum chemistry, hematology, or urinalysis outcomes nor gross or microscopic observations attributable to TBS. These data demonstrate that TBS is safe and well-tolerated when administered to 16-week-old cats at multiples of the approved dose and duration and supports clinical safety in the event of delayed buprenorphine metabolism, medication errors, or alterations in the dosing regimen.

Topics: Analgesia; Analgesics, Opioid; Animals; Buprenorphine; Cat Diseases; Cats; Female; Male; Mydriasis; Pain, Postoperative

This study assesses the efficiency of the buprenorphine patch system compared to the routine use of tramadol intramuscular injections in the context of the South African public healthcare sector.. Patients were randomised into two groups, who received routine tramadol injections 100 mg every 8 hours intramuscular and buprenorphine patches 5 mcg every hour. The study assessed the first 48 hours postoperatively. A visual discrete pain scale was used to assess the level of postoperative pain as well as all complications associated with insufficient analgesic administration.. The sample size included 75 patients in the tramadol group and 75 patients in the buprenorphine patch group. Nine patients (12%,. The study showed that the use of the buprenorphine patch is a reliable and effective method of postoperative analgesia, although it is slightly more expensive compared to the routine use of tramadol. The buprenorphine patch showed significantly better results in all assessed parameters; thus, it may be recommended for use at the Dr George Mukhari Academic Hospital (DGMAH).

Topics: Analgesics; Analgesics, Opioid; Buprenorphine; Humans; Pain, Postoperative; Tramadol

Rabbits are especially susceptible to adverse effects related to surgery, which can lead to inappetence and gastrointestinal (GI) stasis. However, these adverse effects may be related to discomfort from the procedure, anesthesia, the analgesics used, and the stress of restraint for analgesic administration. Opioid and NSAID analgesics which are frequently used in rabbits, can contribute to these adverse effects. This study compared the clinical GI side effects of buprenorphine and carprofen to saline controls in New Zealand White rabbits after a nonsurgical anesthetic event. Nine rabbits (3 females and 6 males, aged 8 to 20 mo) were randomly rotated through 5 treatment groups with a 7-d washout period between treatments: anesthesia control (no treatment), buprenorphine (0.05 mg/kg SC every 12 h for 72 h), carprofen (5 mg/kg SC every 24 h for 72 h), twice daily saline control (equivalent volume to buprenorphine SC every 12 h for 72 h), and once daily saline control (equivalent volume to carprofen SC every 24 h for 72 h). All rabbits were anesthetized 5 times and received initial treatments on the day of anesthesia. Generalized linear mixed models were used to assess food intake, water intake, and fecal output score for 7 days after anesthesia. Analysis showed that buprenorphine-treated rabbits had a significant 4-d decrease in food intake and a 3-d decrease in fecal output score compared with baseline. None of the other treatment groups showed any changes in food intake or fecal output score compared with baseline. These findings demonstrate that in the absence of pain, buprenorphine significantly depresses food intake in rabbits and that restraint and injections have minimal effect on food intake despite the possibility of increased stress.

Topics: Analgesics; Analgesics, Opioid; Animals; Appetite; Buprenorphine; Female; Male; Pain, Postoperative; Rabbits

An increasing number of individuals are taking buprenorphine for management of opioid use disorder (OUD). Pain control can be challenging when these patients develop acute pain requiring supplemental analgesia. Buprenorphine's pharmacokinetic profile can render supplemental opioid-based analgesia ineffective. There is limited guidance on the optimal management of buprenorphine when acute pain is anticipated. Although there is growing acceptance that the risk of OUD relapse with buprenorphine discontinuation overshadows the risks of increased opioid utilization and difficult pain control with buprenorphine continuation, perioperative courses comparing buprenorphine dose reduction and full dose buprenorphine continuation have yet to be investigated. Here, we describe the protocol for our randomized controlled, prospective trial investigating the effect of buprenorphine continuation compared to buprenorphine dose reduction on pain control, post-operative opioid use, and OUD symptom management in patients on buprenorphine scheduled for elective surgery.. This is a single institution, randomized trial that aims to enroll 80 adults using 12 mg buprenorphine or greater for treatment of OUD, scheduled for elective surgery. Participants will be randomly assigned to receive 8mg of buprenorphine on the day of surgery onwards until postsurgical pain subsides or to have their buprenorphine formulation continued at full dose perioperatively. Primary outcome will be a clinically significant difference in pain scores 24 hours following surgery. Secondary outcomes will be opioid consumption at 24, 48, and 72 hours postoperatively, opioid dispensing up to 30 days following surgery, changes in mood and withdrawal symptoms, opioid cravings, relapse of opioid misuse, and continued use of buprenorphine treatment postoperatively.

Topics: Acute Pain; Adult; Analgesics, Opioid; Buprenorphine; Drug Tapering; Humans; Opiate Substitution Treatment; Opioid-Related Disorders; Pain, Postoperative; Prospective Studies

The presence of opioid receptors around the peripheral nerves offers the possibility of providing postoperative analgesia, thereby encouraging the study of the effect of opioids in combination with local anesthesia (LA). Studies have also reported the efficacy of peripherally administered opioids in achieving adequate analgesia in regions with inflammation. Applying the concept of peripheral opioid receptors, our study aimed to evaluate the effectiveness of opioid analgesia in managing postoperative pain. The split-mouth study was carried out to evaluate the efficacy of buprenorphine added to lidocaine 2% in providing postoperative analgesia after the surgical extraction of the impacted mandibular third molar.. We conducted a randomized, double-blinded, split-mouth trial among 21 patients with impacted mandibular third molars bilaterally. In all patients, bilateral impacted mandibular third molars were extracted at different periods. The primary outcomes assessed were postoperative analgesia by the VAS score and the number of rescue analgesics consumed by patients at 24, 48, and 72 hours of interval via a questionnaire.. There was a statistical significant difference in postoperative analgesia duration at 24 (. Buprenorphine added to lidocaine 2% showed a minimal decrease in the pain score and duration of postoperative analgesia with no difference in the frequency of rescue analgesics consumed between the test and control.

Topics: Adult; Analgesics; Buprenorphine; Double-Blind Method; Female; Humans; Lidocaine; Male; Mandible; Molar, Third; Nerve Block; Pain Measurement; Pain, Postoperative; Tooth Extraction; Young Adult

Identifying early indicators of distress in mice is difficult using either periodic monitoring or current technology. Likewise, poor pain identification remains a barrier to providing appropriate pain relief in many mouse models. The Time to Incorporate to Nest Test (TINT), a binary measure of the presence or absence of nesting behavior, was developed as a species-specific method of identifying moderate to severe distress and pain in mice. The current study was designed to evaluate alterations in nesting behavior after routine surgery and to validate the TINT's ability to measure pain-related behavioral changes. CD1 mice undergoing carotid artery catheterization as part of a commercial surgical cohort were randomly assigned various nesting, surgery, and analgesia conditions. To provide context for the TINT outcomes, we measured other variables affected by pain, such as weight loss, food consumption, and scores derived from the Mouse Grimace Scale (MGS). Mice that had surgery were more likely to have a negative TINT score as compared with controls. All mice were more likely to fail the TINT after receiving postoperative buprenorphine, suggesting that buprenorphine may have contributed to the failures. The TINT, MGS live scoring, and scoring MGS images all loaded strongly on a single component in a principal component analysis, indicating strong convergent validity between these measures. These data indicate that the TINT can provide a quick, objective indicator of altered welfare in mice, with the potential for a wide range of uses.

Topics: Analgesia; Analgesics, Opioid; Animals; Buprenorphine; Laboratory Animal Science; Mice; Nesting Behavior; Pain; Pain Management; Pain Measurement; Pain, Postoperative; Species Specificity

Total knee arthroplasty (TKA) is associated with moderate-to-severe postoperative pain. Satisfactory perioperative analgesia is essential for a good and predictable surgical outcome. Effective postoperative pain control is a major challenge to the treating surgeon and his team. Old age and multiple comorbidities restrict the choice of analgesics one can offer. Transdermal buprenorphine (TDB), widely used in chronic pain management, has been rarely studied in acute postoperative setting. The purpose of this study was to compare the safety and efficacy of a TDB patch to conventional analgesics after knee arthroplasty surgery.. A prospective randomized study was conducted with 200 patients aged 60-75 years undergoing TKA surgery under neuraxial anesthesia. All patients received periarticular local anesthetic infiltration and epidural/femoral nerve block infusion for 72 hours postoperatively. Group A received the TDB patch 5 mcg applied at the end of surgery. Group B received a combination of paracetamol and tramadol. All patients received intravenous diclofenac as rescue analgesia. Pain scores at rest, on movement, and side effects, if any, were compared over 7 days using the numerical rating scale score.. Pain scores at rest and on movement were significantly lower in group A (P values .008 and .01). Rescue analgesia requirement was also significantly less in this group. Only one patient had clinically significant respiratory depression, and 3 patients had local erythema.. Our data shows that the TDB patch is more efficacious in reducing postoperative pain after TKA surgery and can be safely used with fewer systemic side effects when compared to conventional analgesics.

Topics: Aged; Analgesics, Opioid; Anesthetics, Local; Arthroplasty, Replacement, Knee; Buprenorphine; Humans; Middle Aged; Pain Measurement; Pain, Postoperative; Prospective Studies; Transdermal Patch

Buprenorphine is used for canine postoperative pain management. This study aimed to describe the pharmacokinetics and evaluate the analgesic efficacy of buprenorphine (Simbadol, 1.8 mg/mL) administered by different routes in dogs undergoing ovariohysterectomy. Twenty-four dogs were included in a randomized, prospective, masked, clinical trial. Buprenorphine (0.02 mg/kg) was administered intravenously (IV), intramuscularly (IM) or subcutaneously (SC) (n = 8/group) 0.5 h before general anesthesia with propofol-isoflurane. Carprofen (4.4 mg/kg SC) was administered after anesthetic induction and before ovariohysterectomy. Pain was scored using the short-form Glasgow composite pain scale for dogs (SF-GCPS). Dogs were administered morphine (0.25 mg/kg IV) when SF-GCPS scores were ≥ 5/20. Blood sampling was performed up to 720 min after drug administration. Plasma buprenorphine and norbuprenorphine concentrations were analyzed using liquid chromatography mass spectrometry. Pharmacokinetics of buprenorphine was described using a non-compartmental model (PK Solver 2.0). Statistical analysis was performed using linear mixed models and Fisher's exact test (p < 0.05).. Pain scores were significantly higher than baseline after IV (0.5-2 h), IM (0.5-3 h) and SC (0.5-4 h) but not among groups. Prevalence of rescue analgesia was significantly higher in SC (7/8 dogs) than IV (2/8) but not different between IV and IM (3/8) or IM and SC. The frequency of rescue analgesia was not significantly different among groups (IV = 2, IM = 5 and SC = 9). Norbuprenorphine was not detected. For IV, IM and SC administration, clearance was 1.29, 1.65 and 1.40 L/hour/kg, volume of distribution was 6.8, 14.2 and 40.1 L/kg, the elimination half-life was 3.7, 5.7, 22 h, and the area under the plasma concentration-time curved extrapolated to infinity was 15.7, 12.4 and 16.4 ng/mL/hour, respectively. Bioavailability for IM and SC was 62.6 and 40%, respectively. Maximum plasma concentrations of buprenorphine were 6.2 and 1.3 ng/mL at 0.14 and 0.33 h after IM and SC administration, respectively.. The route of administration influences the analgesic efficacy of buprenorphine in dogs. SC administration of buprenorphine failed to provide clinical analgesia due to erratic drug absorption. At the doses administered, the IV and IM routes are preferred for postoperative analgesia.

Topics: Administration, Intravenous; Analgesia; Analgesics, Opioid; Animals; Buprenorphine; Dogs; Female; Hysterectomy; Injections, Intramuscular; Injections, Subcutaneous; Ovariectomy; Pain Measurement; Pain, Postoperative; Prospective Studies

The efficacy and safety of buprenorphine transdermal patch (BTP) has been well established in chronic pain, but data regarding acute postoperative pain relief is still very limited. Therefore, we design a prospective, randomized, controlled study to evaluate the effectiveness and safety of the BTP for postoperative analgesia in total hip arthroplasty.. This study is designed as a single-center, prospective, double-blind, randomized controlled trial. Group A receives a 10 mg patch of buprenorphine at the conclusion of surgery which is continued for 14 days. Group B receives a conventional analgesic regimen, that is, IV paracetamol 1 mg every 8 hours alternating with parenteral tramadol 50 mg every 8 hours for the first 2 postoperative days followed by oral administration of the same drug still the end of 2 weeks. A total of 160 patients are needed with an allowance for 10% drop-out. The primary outcome of this noninferiority study is opioid consumption within the first 24 hours following surgery. The secondary outcomes included numerical rating scale scores at rest, postoperative complications, length of hospital stay, and patient satisfaction.. This trial is expected to be the largest randomized trial assessing the efficacy of BTP after primary total hip arthroplasty and powered to detect a potential difference in the primary outcome.. This study protocol was registered in Research Registry (researchregistry5524).

Topics: Acetaminophen; Administration, Intravenous; Administration, Oral; Analgesics, Non-Narcotic; Analgesics, Opioid; Arthroplasty, Replacement, Hip; Buprenorphine; Case-Control Studies; Double-Blind Method; Female; Humans; Length of Stay; Male; Pain Measurement; Pain, Postoperative; Patient Satisfaction; Postoperative Complications; Prospective Studies; Tramadol; Transdermal Patch

We investigated the effectiveness of cocktail therapy after arthroscopic rotator cuff repair (ARCR).. We evaluated 128 shoulders undergoing ARCR and used block randomization to divide patients into 2 groups in this double-blind trial: The cocktail group received 20 mL of 0.75% ropivacaine, 5 mg of morphine, 0.3 mg of epinephrine, 2 mg of betamethasone, and saline solution to a total of 42 mL, whereas the control group received 20 mL of 0.75% ropivacaine and saline solution to a total of 42 mL. Postoperatively, one of the drug mixtures was injected into the glenohumeral joint, subacromial bursa, suprascapular nerve, and anterior, middle, and posterior parts of the deltoid muscle according to the treatment group. We recorded patients' visual analog scale scores preoperatively and at 4, 8, 16, 24, and 48 hours postoperatively; the number of patients using postoperative diclofenac suppositories and buprenorphine hydrochloride; the number of patients experiencing nausea; the number of patients with infection and delayed wound healing as adverse effects; the surgery time; the retear rate; and passive shoulder range of motion.. The cocktail group constituted 64 shoulders (50.0%), with 39 men (60.9%) and 25 women (39.1%); the mean age was 64.2 ± 10.2 years. The control group constituted 64 shoulders (50.0%), with 41 men (64.1%) and 23 women (35.9%); the mean age was 65.2 ± 7.5 years. We found no significant difference in age or sex between the 2 groups. There was also no significant difference in rotator cuff tear size or surgery time between the 2 groups. The visual analog scale scores at 8, 16, and 24 hours postoperatively were significantly lower in the cocktail group. The number of patients using suppositories was also significantly lower in the cocktail group. The number of patients receiving buprenorphine injections tended to be lower in the cocktail group, but the difference was not significant. Nausea occurred in 6.3% of patients in the cocktail group and 15.6% in the control group, but the difference was not significant. No infection or delayed wound healing occurred in either group. There was no significant difference in the retear rate between the 2 groups. Passive anterior elevation at 3 months postoperatively was significantly better in the cocktail group than in the control group.. We compared cocktail therapy and ropivacaine after ARCR and found no difference in results except for VAS score at 8, 16, and 24 hours postoperatively and frequency of postoperative suppository use without an apparent risk of infection or a detrimental effect on tendon healing.

Topics: Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Arthroscopy; Betamethasone; Buprenorphine; Diclofenac; Double-Blind Method; Drug Therapy, Combination; Epinephrine; Female; Humans; Injections, Intra-Articular; Injections, Intramuscular; Male; Middle Aged; Morphine; Nausea; Nerve Block; Operative Time; Pain Management; Pain, Postoperative; Range of Motion, Articular; Recurrence; Ropivacaine; Rotator Cuff Injuries; Shoulder Joint; Surgical Wound Infection; Vasoconstrictor Agents; Wound Healing

To compare analgesic efficacy and fetal effects between transdermal administration of fentanyl and IM administration of buprenorphine in pregnant sheep.. 12 healthy pregnant ewes.. Before study initiation, each ewe was confirmed pregnant with a single fetus between 113 and 117 days of gestation. Ewes were randomly assigned to receive buprenorphine (0.01 mg/kg, IM, q 8 h for 48 hours beginning 1 hour before anesthesia induction; n = 6) or fentanyl (a combination of transdermal fentanyl patches sufficient to deliver a dose of 2 μg of fentanyl/kg/h applied between the dorsal borders of the scapulae 24 hours before anesthesia induction; 6). Ewes were anesthetized and underwent a surgical procedure to instrument the fetus with an arterial catheter and place a catheter in utero for collection of amniotic fluid samples. Physiologic variables and behavioral changes indicative of pain were assessed, and amniotic fluid and blood samples from ewes and fetuses were collected for determination of drug concentrations at predetermined times.. Both protocols provided acceptable postoperative analgesia with no adverse effects observed in the ewes or fetuses. Compared with the buprenorphine protocol, the fentanyl protocol induced more profound analgesia, decreased the requirement for isoflurane during surgery, and was associated with a shorter anesthesia recovery time. Fetal indices did not differ significantly between the 2 analgesic protocols.. Results indicated that both protocols provided acceptable analgesia. However, the fentanyl protocol was superior in regard to the extent of analgesia induced, inhalant-sparing effects, and anesthesia recovery time.

Topics: Administration, Cutaneous; Analgesics; Analgesics, Opioid; Animals; Buprenorphine; Female; Fentanyl; Fetus; Pain, Postoperative; Pregnancy; Sheep

This study was performed to evaluate the analgesic efficacy and safety of transdermal buprenorphine (TDB) patched for post-operative pain control after total knee arthroplasty (TKA). The hypothesis was that patients receiving the TDB patch would have less pain in comparison to those treated with the oral COX-2 inhibitor celecoxib without increasing side effects.. A total of 160 patients scheduled for primary TKA were randomly assigned to two groups: patients provided the TDB patch (10μg/h) (TDB group) and those provided oral celecoxib (CX group). The outcomes were pain scores measured using the visual analogue scale (VAS) during rest and activity, as well as morphine requirement, operated knee functional recovery and adverse events post-operatively.. The total morphine given during the first 72h post-operatively was significantly lower in the TDB group than CX group. The VAS scores were significantly lower in the TDB group than CX group during rest at 2, 4, 6, 12, 24 and 48h post-operatively, and during activity at 12, 24 and 48h and 3 days post-operatively. The mean range of motion on post-operative days (PD) 1, 2 and 3 were significantly greater in the TDB group. In addition, the Lysholm score was significantly higher in the TDB group on PD 3. There were no remarkable adverse events in either group.. Use of the TDB patch provides effective pain relief and reduces the requirement for rescue morphine without increasing side effects in comparison with oral celecoxib during the early post-operative stage following TKA.. II.

Topics: Analgesics, Opioid; Arthroplasty, Replacement, Knee; Buprenorphine; Celecoxib; Humans; Pain Management; Pain, Postoperative; Treatment Outcome

We tested the hypothesis that buprenorphine-clonidine-dexamethasone (BCD) extends perineural analgesia compared with plain bupivacaine (BPV) nerve blocks used for hip and knee replacement surgery.. Prospective, parallel-arms, randomized, double-blind trial.. A single veterans' hospital.. Seventy-eight veterans scheduled for total hip or knee replacement with plans for spinal as the primary anesthetic.. Participants underwent nerve/plexus blocks at L2-L4 and L4-S3 in advance of hip or knee joint replacement surgery. Patients were randomized to receive BPV-BCD or plain BPV in a 4:1 allocation ratio. Patients answered four block duration questions (listed below). Time differences between treatments were analyzed using the t test.. Significant (P < 0.001) prolongation of the time parameters was reported by patients after the BPV-BCD blocks (N = 62) vs plain BPV (N = 16). The time until start of postoperative pain was 26 vs 11 hours (mean difference = 15 hours, 95% CI = 8 to 21). The time until no pain relief from the blocks was 32 vs 15 hours (mean difference = 17 hours, 95% CI = 10 to 24). The time until the numbness wore off was 37 vs 21 hours (mean difference = 16 hours, 95% CI = 8 to 23). The time until the worst postoperative pain was 39 vs 20 hours (mean difference = 19 hours, 95% CI = 11 to 27).. BPV-BCD provided 26-39 hours of perineural analgesia in the L2-L4 and L4-S3 nerve distributions after hip/knee replacement surgery, compared with 11-21 hours for plain BPV.

Topics: Analgesia; Anesthetics, Local; Bupivacaine; Buprenorphine; Clonidine; Dexamethasone; Double-Blind Method; Humans; Hypesthesia; Pain Measurement; Pain, Postoperative; Prospective Studies

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.. 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).. 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).. 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.

Topics: Abdominal Wall; Adult; Aged; Analgesics, Opioid; Anesthetics, Local; Buprenorphine; Dexamethasone; Double-Blind Method; Female; Hernia, Inguinal; Herniorrhaphy; Humans; Levobupivacaine; Male; Middle Aged; Nerve Block; Pain Measurement; Pain, Postoperative; Prospective Studies; Ultrasonography, Interventional

This study compared the results of regional blocks containing a single anesthetic, bupivacaine, with those containing bupivacaine and 3 additives (buprenorphine, clonidine, and dexamethasone) in patients undergoing foot and ankle surgery.. Eighty patients undergoing foot and ankle surgery over a 9-month period were prospectively enrolled and randomized to receive a peripheral nerve block containing either a single anesthetic (SA) or one with 3 additives (TA). Patients, surgeons, and anesthesiologists were blinded to the groups. Patients maintained pain diaries and were evaluated at 1 and 12 weeks postoperatively. Fifty-six patients completed the study.. The TA group had a longer duration of analgesic effect than the SA group (average 82 vs 34 hours,. Both types of nerve blocks provided equivalent pain control and patient satisfaction in patients undergoing foot and ankle surgery. The 3-additive agent blocks were associated with a longer duration of pain relief and a longer duration of numbness, as well as higher rates of postoperative neurologic symptoms. Longer pain relief may be obtained at the cost of prolonged sensory deficits.. Level II, prospective comparative study.

Topics: Anesthetics; Ankle; Bupivacaine; Buprenorphine; Clonidine; Dexamethasone; Double-Blind Method; Female; Foot; Humans; Male; Nerve Block; Orthopedic Procedures; Pain Measurement; Pain, Postoperative; Prospective Studies

Objectives The aim of the study was to evaluate the analgesic efficacy of gabapentin-buprenorphine in comparison with meloxicam-buprenorphine or buprenorphine alone, and the correlation between two pain-scoring systems in cats. Methods Fifty-two adult cats were included in a randomized, controlled, blinded study. Anesthetic protocol included acepromazine-buprenorphine-propofol-isoflurane. The gabapentin-buprenorphine group (GBG, n = 19) received gabapentin capsules (50 mg PO) and buprenorphine (0.02 mg/kg IM). The meloxicam-buprenorphine group (MBG, n = 15) received meloxicam (0.2 mg/kg SC), buprenorphine and placebo capsules (PO). The buprenorphine group (BG, n = 18) received buprenorphine and placebo capsules (PO). Gabapentin (GBG) and placebo (MBG and BG) capsules were administered 12 h and 1 h before surgery. Postoperative pain was evaluated up to 8 h after ovariohysterectomy using a multidimensional composite pain scale (MCPS) and the Glasgow pain scale (rCMPS-F). A dynamic interactive visual analog scale (DIVAS) was used to evaluate sedation. Rescue analgesia included buprenorphine and/or meloxicam if the MCPS ⩾6. A repeated measures linear model was used for statistical analysis ( P <0.05). Spearman's rank correlation between the MCPS and rCMPS-F was evaluated. Results The prevalence of rescue analgesia with a MCPS was not different ( P = 0.08; GBG, n = 5 [26%]; MBG, n = 2 [13%]; BG, n = 9 [50%]), but it would have been significantly higher in the BG (n = 14 [78%]) than GBG ( P = 0.003; n = 5 [26%]) and MBG ( P = 0.005; n = 4 [27%]) if intervention was based on the rCMPS-F. DIVAS and MCPS/rCMPS-F scores were not different among treatments. A strong correlation was observed between scoring systems ( P <0.0001). Conclusions and relevance Analgesia was not significantly different among treatments using an MCPS. Despite a strong correlation between scoring systems, GBG/MBG would have been superior to the BG with the rCMPS-F demonstrating a potential type II error with an MCPS due to small sample size.

Topics: Analgesics, Opioid; Animals; Buprenorphine; Cat Diseases; Cats; Gabapentin; Hysterectomy; Ovariectomy; Pain Management; Pain Measurement; Pain, Postoperative; Random Allocation

To determine the noninferior postoperative analgesic efficacy of cimicoxib compared to buprenorphine following elective ovariohysterectomy in healthy bitches.. Prospective, randomized, blinded, controlled clinical trial.. A total of 63 healthy dogs.. To provide perioperative analgesia, cimicoxib 2 mg kg. The GCPS, pain NRS and MNT tests demonstrated noninferiority of cimicoxib compared to buprenorphine (rejection of inferiority: p < 0.001, all). Furthermore, cimicoxib provided better analgesia compared to buprenorphine alone according to the GCPS (p < 0.01) and NRS (p < 0.05), but not the MNT. Conversely, an increase in the analgesic effect when cimicoxib was combined with buprenorphine was only observed with the MNT (p < 0.01). There were no differences in rescue analgesia requirements both intra- and postoperatively between treatments. Gastrointestinal side effects were increased in dogs administered cimicoxib, whereas dogs treated with buprenorphine had higher sedation scores 1-hour postoperatively and required lower doses of propofol for the induction of anaesthesia.. Cimicoxib has noninferior postoperative analgesic efficacy compared to buprenorphine, and both drugs have comparable analgesic effects for the control of postoperative pain in bitches undergoing ovariohysterectomy.

Topics: Analgesia; Analgesics; Animals; Buprenorphine; Dog Diseases; Dogs; Drug Therapy, Combination; Female; Hysterectomy; Imidazoles; Ovariectomy; Pain, Postoperative; Sulfonamides

To investigate whether preoperative methadone provides superior perioperative analgesia compared to buprenorphine in dogs undergoing ovariohysterectomy.. Eighty female dogs were recruited to an assessor-blinded, randomised, clinical trial. Dogs received a premedication dose of 0·05 mg/kg acepromazine or 10 μg/kg medetomidine combined with either 0·3 mg/kg methadone or 20 μg/kg buprenorphine intramuscularly. Anaesthesia was induced with propofol and maintained with isoflurane. Pain was assessed using two scoring schemes (a dynamic interactive visual analogue scale and the short form of the Glasgow Composite Pain Scale) before premedication, 30 minutes later and every hour for 8 hours after premedication. If indicated, rescue analgesia was provided with methadone. Meloxicam was administered after the final assessment. The area under the curve for change in pain scores over time and the requirement for rescue analgesia were compared between groups.. Groups premedicated with buprenorphine had significantly higher pain scores than those premedicated with methadone. There was no interaction between opioid and sedative for any outcome measure. Rescue analgesia was required by significantly more dogs premedicated with buprenorphine (45%) than that of methadone (20%).. At the doses investigated, methadone produced superior postoperative analgesia compared to buprenorphine in dogs undergoing ovariohysterectomy.

Topics: Acepromazine; Analgesia; Analgesics, Opioid; Animals; Buprenorphine; Dogs; Female; Hypnotics and Sedatives; Hysterectomy; Medetomidine; Methadone; Ovariectomy; Pain Measurement; Pain, Postoperative; Random Allocation

Peripheral nerve blockade is used to provide analgesia for patients undergoing total knee arthroplasty. This study compared a single-injection adductor canal block (SACB) with adjuvants to continuous adductor canal blockade (CACB). The hypothesis was that the 2 groups would have equivalent analgesia at 30 hours after neural blockade.. This was a double-blinded, randomized, controlled, equivalency trial. Sixty patients were randomized to either the SACB group (20 mL of 0.25% bupivacaine, 1.67 mcg/mL of clonidine, 2 mg of dexamethasone, 150 mcg of buprenorphine, and 2.5 mcg/mL of epinephrine) or the CACB group (20 mL 0.25% of bupivacaine injection with 2.5 mcg/mL of epinephrine followed by an 8 mL/h infusion of 0.125% bupivacaine continued through postoperative day 2). The primary outcome was movement pain scores at 30 hours using the numeric rating scale (NRS). The secondary outcomes included serial postoperative NRS pain scores (rest and movement every 6 hours), opioid consumption, time to first opioid administration, ability to straight leg raise, patient satisfaction, length of stay, and the incidence of nausea/vomiting.. An intention-to-treat analysis included 59 patients. The NRS pain scores with movement were equivalent at 30 hours (SACB 5.5 ± 2.8 vs CACB 5.7 ± 2.9 [mean NRS ± standard deviation]; mean difference 0.2 [-1.5 to 1.0 {90% confidence interval}]). All NRS pain scores were equivalent until 42 hours (rest) and 48 hours (rest and movement) with the CACB group having lower pain scores. Other secondary outcomes were not statistically different.. An SACB provides equivalent analgesia for up to 36 hours after block placement when compared with a CACB for patients undergoing total knee arthroplasty, though a CACB was favored at 42 hours and beyond.

Topics: Aged; Analgesia; Anesthetics, Local; Arthroplasty, Replacement, Knee; Bupivacaine; Buprenorphine; Catheterization; Clonidine; Dexamethasone; Double-Blind Method; Epinephrine; Female; Humans; Infusions, Parenteral; Injections; Male; Middle Aged; Nerve Block; Pain Management; Pain Measurement; Pain, Postoperative; Patient Satisfaction; Prospective Studies

Managing postoperative pain in rodents is an important part of any animal care and use program, and identifying an optimal analgesic plan for a surgical procedure is critical to providing for animal welfare. Opioids and NSAID are commonly used in rodents, but few studies have evaluated their efficacy in surgical models. The current study aimed to evaluate the therapeutic efficacy of clinically relevant doses of buprenorphine (2 formulations) or meloxicam used in combination with ketamine and xylazine anesthesia in a Sprague-Dawley rat ovariohysterectomy surgical model. Rats received either subcutaneous saline once daily for 3 d, low-dose (0.05 mg/kg SC) or high-dose (0.1 mg/kg SC) buprenorphine twice daily for 3 d, a single injection of sustained-release buprenorphine (1.2 mg/kg SC), or low-dose (1 mg/kg SC) or high-dose (2 mg/kg SC) meloxicam once daily for 3 d. Clinical analgesic efficacy was assessed over 8 d according to cageside observation scoring, body weight, and behavioral testing. Ovariohysterectomy was associated with 2 d of postoperative pain, and all 3 buprenorphine dosing strategies and both doses of meloxicam demonstrated varying amounts of analgesia. Given the results of the current study, we recommend 0.05 mg/kg SC buprenorphine at least twice daily or a single dose of 1.2 mg/kg SC of sustained-release buprenorphine for rats undergoing midline laparotomy with ovariohysterectomy. Alternatively, meloxicam at 1 to 2 mg/kg SC once daily could be used for this indication.

Topics: Analgesia; Analgesics, Opioid; Animals; Anti-Inflammatory Agents, Non-Steroidal; Body Weight; Buprenorphine; Female; Laboratory Animal Science; Laparotomy; Meloxicam; Pain Measurement; Pain, Postoperative; Rats; Rats, Sprague-Dawley

Buprenorphine is a potent lipophilic opioid analgesic that is largely used in the multimodal treatment of acute pain. Simbadol (buprenorphine hydrochloride) is the first and only FDA-approved high-concentration formulation of buprenorphine for use in cats. The aim of this study was to evaluate the analgesic efficacy of carprofen in combination with one of two commercial formulations of buprenorphine (Simbadol and Vetergesic, 1.8 mg/mL and 0.3 mg/mL, respectively) in dogs undergoing ovariohysterectomy. Twenty-four dogs were included in a randomized, prospective, controlled, clinical trial. Patients were randomly divided into 2 groups as follows. Dogs were premedicated with acepromazine (0.02 mg/kg) and either 0.02 mg/kg of Vetergesic or Simbadol intramuscularly (Vetergesic group - VG; Simbadol group - SG, respectively; n = 12/group). General anesthesia was induced with propofol and maintained with isoflurane in 100% oxygen. Carprofen (4.4 mg/kg SC) was administered after induction of anesthesia. Heart rate, respiratory rate, blood pressure, pulse oximetry, pain scores using the Glasgow Composite Pain Scale Short Form (CMPS-SF), sedation scores using a dynamic interactive visual analogue scale and adverse events were evaluated before and after ovariohysterectomy by an observer who was unaware of treatment administration. If CMPS-SF scores were ≥ 5/20, dogs were administered rescue analgesia (morphine 0.5 mg/kg IM). Statistical analysis was performed using linear mixed models and Fisher's exact test (p < 0.05).. Pain and sedation scores and physiological parameters were not significantly different between treatments. Three dogs in VG (25%) and none in SG (0%) required rescue analgesia (p = 0.109). Adverse effects (i.e. vomiting and melena) were observed in two dogs in SG and were thought to be related to stress and/or nonsteroidal anti-inflammatory drug toxicity.. The administration of buprenorphine with carprofen preoperatively provided adequate postoperative analgesia for the majority of dogs undergoing OVH without serious adverse events. Prevalence of rescue analgesia was not significantly different between groups; however, it could be clinically relevant and explained by a type II error (i.e. small sample size). Future studies are necessary to determine if analgesic efficacy after Simbadol and Vetergesic is related to individual variability or pharmacokinetic differences.

Topics: Analgesics, Opioid; Animals; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Carbazoles; Dogs; Drug Therapy, Combination; Female; Hysterectomy; Ovariectomy; Pain Measurement; Pain, Postoperative; Preanesthetic Medication; Prospective Studies

This study aimed to investigate the perioperative analgesic effect of a buprenorphine transdermal patch in patients who underwent simple lumbar discectomy.In total, 96 patients were randomly divided into parecoxib intravenous injection (Group A), oral celecoxib (Group B), and buprenorphine transdermal patch groups (Group C). The pain status, degree of satisfaction, adverse effects, and condition in which the patient received tramadol hydrochloride for uncontrolled pain were recorded on the night before surgery, postoperative day 1, postoperative day 3, and postoperative day 5.The degree of patient satisfaction in Group C was higher than that in Groups A and B, with minimal adverse effects.The buprenorphine transdermal patch had a better perioperative analgesic effect in patients who underwent simple lumbar discectomy.

Topics: Administration, Cutaneous; Administration, Intravenous; Administration, Oral; Analgesics, Opioid; Buprenorphine; Celecoxib; Cyclooxygenase 2 Inhibitors; Diskectomy; Female; Humans; Isoxazoles; Lumbar Vertebrae; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Patient Satisfaction; Perioperative Care; Tramadol; Transdermal Patch; Treatment Outcome

Several adjuvants have been proposed to prolong the effect of peripheral nerve blocks, one of which is buprenorphine. In this randomized double blinded placebo controlled trial we studied whether the addition of buprenorphine to a femoral nerve block prolongs analgesia in patients undergoing total knee arthroplasty in a fast track surgery protocol.. The treatment group (B) was given an ultrasound-guided femoral nerve block with ropivacaine 0.2% and 0.3mg buprenorphine. We choose to use 2 control groups. Group R was given a femoral nerve block with ropivacaine 0.2% only. Group S also received 0.3 mg buprenorphine subcutaneously. Only patients with a successful block were enrolled in the study.. We found no difference in our primary outcome parameter of time to first rescue analgesic. We found lower opioid use and better sleep quality the first postoperative night in patients receiving buprenorphine perineurally or subcutaneously. Buprenorphine did not lead to any significant change in pain or mobilization. We found a high overall incidence of nausea and vomiting.. In patients undergoing total knee arthroplasty, in the setting of a fast track surgery protocol, the addition of buprenorphine to a femoral nerve block did not prolong analgesia.

Topics: Aged; Aged, 80 and over; Amides; Analgesics, Opioid; Anesthetics, Local; Arthroplasty, Replacement, Knee; Buprenorphine; Double-Blind Method; Drug Therapy, Combination; Female; Femoral Nerve; Humans; Male; Middle Aged; Nerve Block; Pain Measurement; Pain, Postoperative; Ropivacaine; Time Factors; Treatment Failure; Ultrasonography

To compare the efficacy of a transdermal buprenorphine patch (5, 10, 15, and 20 μg/h) with that of oral tramadol (150, 200, 250, and 300 mg) for postoperative pain control after single level spinal fusion surgery.. The present study (ClinicalTrials.gov, number NCT02416804) was a prospective, randomized controlled non-inferiority trial designed to determine the efficacy of buprenorphine TDS for alleviating postoperative pain following patient controlled analgesia (PCA) in persons underwent a single level posterior lumbar interbody fusion surgery through 1:1 allocation. The primary outcome was the Visual Analog Pain Scale (VAS) score for postoperative back pain at 7 days after surgery. The non-inferior margin of the VAS was set at δ = 1.5 points.. The VAS score (primary outcome) for postoperative back pain at 7 days after surgery in the Buprenorphine group was not inferior compared to the Tramadol group. The overall changes in VAS scores for postoperative pain during follow-up assessments over a 2-week period did not differ between both groups. However, the VAS scores for postoperative pain significantly improved with time after surgery in both groups. The patterns of changes in the VAS scores for postoperative pain during the follow-up period were not significantly different between the both groups.. The efficacy of buprenorphine TDS was not inferior to that of oral tramadol medication for alleviating postoperative pain in the subacute period from 72 h after surgery, following PCA administration. In addition, adverse events were similar between both groups.

Topics: Buprenorphine; Humans; Pain Measurement; Pain, Postoperative; Prospective Studies; Spinal Fusion; Tablets; Tramadol; Transdermal Patch; Treatment Outcome

OBJECTIVE To evaluate agreement between observers with different training and experience for assessment of postoperative pain and sedation in cats by use of a dynamic and interactive visual analog scale (DIVAS) and for assessment of postoperative pain in the same cats with a multidimensional composite pain scale (MCPS). DESIGN Randomized, controlled, blinded study. ANIMALS 45 adult cats undergoing ovariohysterectomy. PROCEDURES Cats received 1 of 3 preoperative treatments: bupivacaine, IP; meloxicam, SC with saline (0.9% NaCl) solution, IP, (positive control); or saline solution only, IP (negative control). All cats received premedication with buprenorphine prior to general anesthesia. An experienced observer (observer 1; male; native language, Spanish) used scales in English, and an inexperienced observer (observer 2; female; native language, French) used scales in French to assess signs of sedation and pain. Rescue analgesia was administered according to MCPS scoring by observer 1. Mean pain and sedation scores per treatment and time point, proportions of cats in each group with MCPS scores necessitating rescue analgesia, and mean MCPS scores assigned at the time of rescue analgesia were compared between observers. Agreement was assessed by intraclass correlation coefficient determination. Percentage disagreement between observers on the need for rescue analgesia was calculated. RESULTS Interobserver agreements for pain scores were good, and that for sedation scores was fair. On the basis of observer 1's MCPS scores, a greater proportion of cats in the negative control group received rescue analgesia than in the bupivacaine or positive control groups. Scores from observer 2 indicated a greater proportion of cats in the negative control group than in the positive control group required rescue analgesia but identified no significant difference between the negative control and bupivacaine groups for this variable. Overall, disagreement regarding need for rescue analgesia was identified for 22 of 360 (6.1%) paired observations. CONCLUSIONS AND CLINICAL RELEVANCE Interobserver differences in assessing pain can lead to different conclusions regarding treatment effectiveness.

Topics: Analgesia; Animals; Bupivacaine; Buprenorphine; Cats; Female; Hysterectomy; Observer Variation; Ovariectomy; Pain Measurement; Pain, Postoperative; Pathologists; Reproducibility of Results

Postoperative secondary hyperalgesia arises from central sensitization due to pain pathways facilitation and/or acute opioid exposure. The latter is also known as opioid-induced hyperalgesia (OIH). Remifentanil, a potent μ-opioid agonist, reportedly induces postoperative hyperalgesia and increases postoperative pain scores and opioid consumption. The pathophysiology underlying secondary hyperalgesia involves N-methyl-D-aspartate (NMDA)-mediated pain pathways. In this study, we investigated whether perioperatively infusing low-dose buprenorphine, an opioid with anti-NMDA activity, in patients receiving remifentanil infusion prevents postoperative secondary hyperalgesia.. Sixty-four patients, undergoing remifentanil infusion during general anaesthesia and major lung surgery, were randomly assigned to receive either buprenorphine i.v. infusion (25 μg h-1 for 24 h) or morphine (equianalgesic dose) perioperatively. The presence and extent of punctuate hyperalgesia were assessed one day postoperatively. Secondary outcome variables included postoperative pain scores, opioid consumption and postoperative neuropathic pain assessed one and three months postoperatively.. A distinct area of hyperalgesia or allodynia around the surgical incision was found in more patients in the control group than in the treated group. Mean time from extubation to first morphine rescue dose was twice as long in the buprenorphine-treated group than in the morphine-treated group: 18 vs 9 min (P=0.002). At 30 min postoperatively, patients receiving morphine had a higher hazard ratio for the first analgesic rescue dose than those treated with buprenorphine (P=0.009). At three months, no differences between groups were noted.. Low-dose buprenorphine infusion prevents the development of secondary hyperalgesia around the surgical incision but shows no long-term efficacy at three months follow-up.

Topics: Aged; Analgesics, Opioid; Buprenorphine; Double-Blind Method; Female; Humans; Hyperalgesia; Infusions, Intravenous; Lung; Male; Middle Aged; Pain, Postoperative; Prospective Studies; Remifentanil

Non-steroidal anti-inflammatory drugs (NSAIDs), transdermal fentanyl patches, and transmucosal buprenorphine are probably the most commonly used options for providing post-operative analgesia in the early at-home period. However, these require daily administration or are associated with abuse concerns. One of the significant unmet needs in veterinary surgery and pain management is for longer acting opioids for cats to effectively bridge the gap between the in-hospital and at-home recovery periods. A proof of concept study of an extended release formulation of buprenorphine HCL (ER-Bup) was conducted using objective kinetic measures and a unilateral onychectomy model. Using a blinded, randomized, two period crossover design, four cats were allocated to control (saline) or ER-Bup (0.6 mg/kg, subcutaneously [SC]) treatment groups. All animals underwent a unilateral forelimb onychectomy per period with a washout/recovery period in between. Observational pain scores and kinetic data (using a pressure sensitive walkway [PSW]) were collected prior to (baseline) and at intervals for 72 h following surgery. Symmetry indices were derived for kinetic variables (peak vertical force [PVF]; vertical impulse [VI]) of each forelimb for landing following a jump and for walking. A rescue analgesic protocol was in place. Effect of surgery and treatment were evaluated using a mixed model statistical approach.. No cats required rescue analgesics based on subjective pain score. ER-Bup had a positive influence on subjective pain scores during the 72 h postsurgery (p = 0.0473). PVF and VI of the operated limb were significantly decreased for both landing (p < 0.0001 and p < 0.0001) and walking (p < 0.0001 and p < 0.0001 respectively) compared to control. ER-Bup resulted in significantly decreased asymmetry in limb use during landing (PVF, p < 0.0001; VI, p < 0.0001) and walking (PVF, p = 0.0002, VI, p < 0.0001). The novel use of data collected following a jump from an elevated platform appeared to provide all desired information and was easier to collect than walking data.. This study demonstrates that SC administration of ER-Bup may be an effective analgesic for a 72 h period postoperatively. Furthermore, landing onto a PSW from an elevated perch may be a useful and efficient way to assess analgesics in cats using a unilateral model of limb pain.

Topics: Analgesics, Opioid; Animals; Buprenorphine; Cats; Delayed-Action Preparations; Female; Hoof and Claw; Male; Motor Activity; Orthopedic Procedures; Pain Measurement; Pain, Postoperative; Pilot Projects

Objectives The aim of this study was to evaluate the analgesic efficacy of intraperitoneal (IP) bupivacaine in cats undergoing ovariohysterectomy (OVH). Methods Forty-five cats were included in a randomized, prospective, blinded study after owners' written consent was obtained. The anesthetic protocol included acepromazine-buprenorphine-propofol-isoflurane. A ventral midline incision was made and cats (n = 15/group) were administered either IP saline 0.9% (negative and positive control groups; NG and PG, respectively) or IP bupivacaine (2 mg/kg; bupivacaine group; BG). Cats in the PG received meloxicam (0.2 mg/kg SC). An OVH was performed and postoperative pain was evaluated using a dynamic interactive visual analog scale (DIVAS), the UNESP-Botucatu multidimensional composite pain scale (MCPS) and mechanical nociceptive thresholds (MNT) for up to 8 h after the end of surgery. Postoperative sedation was evaluated using DIVAS. Rescue analgesia was provided with buprenorphine and/or meloxicam. Repeated measures linear models and a Cochran-Mantel-Haenszel test were used for statistical analysis ( P <0.05). Results There was a significant effect of treatment on the number of times rescue analgesia was administered ( P = 0.002) (PG, n = 2, 13%; NG, n = 12, 80%; BG, n = 4, 27%) with the number of rescues being higher in the NG group than in the PG ( P = 0.0004) and BG ( P = 0.02) groups. The DIVAS, MCPS and MNT were significantly different when compared with baseline values at different time points; however, data were not significantly different among groups. Conclusions and relevance Treatments PG and BG produced similar analgesia in terms of pain scores, number of times rescue analgesia was administered and MNT. Based on rescue analgesia, IP administration of bupivacaine provides analgesia in cats after OVH.

Topics: Analgesics, Opioid; Anesthesia; Anesthetics, Local; Animals; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Cats; Female; Hysterectomy; Injections, Intraperitoneal; Meloxicam; Ovariectomy; Pain Measurement; Pain, Postoperative; Prospective Studies; Thiazines; Thiazoles; Treatment Outcome

To compare the quality of anesthesia and analgesia from femoral and sciatic nerve blocks (FS) with bupivacaine and dexmedetomidine with that from an epidural injection (EPI) with bupivacaine and buprenorphine in dogs undergoing unilateral stifle arthroplasty.. Prospective, blinded, randomized, clinical comparison.. Twenty-six dogs weighing 36 ± 10 kg and aged 5 (1-11) years.. Dogs were randomly assigned to either FS [n = 13; bupivacaine 0.5% (0.5 mg kg(-1) ) plus dexmedetomidine (0.1 μg kg(-1) ) for each nerve] or EPI [n = 13; bupivacaine 0.5% (1 mg kg(-1) ) plus buprenorphine (4 μg kg(-1) )]. Data collected included intraoperative cardiopulmonary variables and postoperative pain scores (Glasgow Composite Pain Scale), sedation scores, opioid consumption, time to urination and time to return of various behaviors. Rescue analgesia (hydromorphone 0.05 mg kg(-1) ) was administered intravenously whenever pain scores were ≥ 6/24. Subsequent data from rescued dogs were excluded from further analysis.. No differences were found for any of the variables evaluated during and after anesthesia. Over 60% (nine dogs in FS, eight dogs in EPI) of patients from either group did not need additional analgesia within the 24 hour observational period. Three and four patients in FS and EPI, respectively, that required rescue analgesia did so within the first 30 minutes after extubation; only one patient in EPI required supplemental analgesia more than 4 hours after extubation. One patient in each group did not urinate spontaneously for 24 hours.. Both techniques have the potential to provide sufficient analgesia for up to 24 hours in approximately two-thirds of dogs. Careful observation for signs of pain and preparedness to intervene is still recommended. The incidence of urinary retention was low in both groups. These techniques show promise for providing high-quality analgesia for stifle arthroplasty.

Topics: Analgesia; Analgesics, Non-Narcotic; Anesthesia; Anesthetics, Local; Animals; Arthroplasty; Bupivacaine; Buprenorphine; Dexmedetomidine; Dogs; Femoral Nerve; Injections, Epidural; Nerve Block; Pain Measurement; Pain, Postoperative; Prospective Studies; Sciatic Nerve; Stifle

This study investigated interscalene block for shoulder arthroplasty with various ropivacaine concentrations in the presence of clonidine, dexamethasone, and buprenorphine. The goal was prolonged analgesia with minimal motor blockade.. Prospective, double-blind, randomized controlled trial.. University-affiliated orthopedic hospital.. Patients (20/group) received acetaminophen, ketorolac, pregabalin, opioids, and "Control"; interscalene block, 0.375% ropivacaine, intravenous additives (buprenorphine, clonidine, dexamethasone); "High Dose"; 0.375% ropivacaine, perineural additives; "Medium Dose"; 0.2% ropivacaine, perineural additives; and "Low Dose"; 0.1% ropivacaine, perineural additives.. Pain with movement at 24 hours was 4.9 ± 2.5 (mean ± standard deviation [SD]) (Control), 4.5 ± 3.0 (High Dose), 3.4 ± 1.8 (Medium Dose), 4.2 ± 2.4 (Low Dose). The difference between Medium Dose and Control was -1.5 (95% CI: -2.9, -0.1) (P = 0.040). Median time until need for opioids was 16.1 hours (Control) vs 23.7 hours (High Dose); hazard ratio 0.37 [95% CI: 0.17, 0.79]. High Dose had less pain with movement the morning after surgery, vs Control; 2.9 ± 2.5 vs 4.9 ± 2.7; P = 0.027. Pain with movement in the Post-Anesthesia Care Unit was higher in Low Dose, vs Control; 0.9 ± 1.4 vs 0 ± 0, P = 0.009. Low Dose had superior hand strength in the Post-Anesthesia Care Unit (mean ± SD of pre-operative strength: 44.0 ± 20.3%) compared to Control (27.5 ± 24.5%) (P = 0.031).. For maximum pain reduction, combining perineural additives with ropivacaine 0.375% or 0.2% is suggested. To minimize motor blockade, perineural additives can be combined with ropivacaine, 0.1%.

Topics: Aged; Amides; Anesthetics, Local; Anti-Inflammatory Agents; Buprenorphine; Clonidine; Dexamethasone; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Nerve Block; Pain Measurement; Pain, Postoperative; Prospective Studies; Ropivacaine

The aim of this blinded, randomised, prospective clinical trial was to determine whether the addition of magnesium sulphate to spinally-administered ropivacaine would improve peri-operative analgesia without impairing motor function in dogs undergoing orthopaedic surgery. Twenty client-owned dogs undergoing tibial plateau levelling osteotomy were randomly assigned to one of two treatment groups: group C (control, receiving hyperbaric ropivacaine by the spinal route) or group M (magnesium, receiving a hyperbaric combination of magnesium sulphate and ropivacaine by the spinal route). During surgery, changes in physiological variables above baseline were used to evaluate nociception. Arterial blood was collected before and after spinal injection, at four time points, to monitor plasma magnesium concentrations. Post-operatively, pain was assessed with a modified Sammarco pain score, a Glasgow pain scale and a visual analogue scale, while motor function was evaluated with a modified Tarlov scale. Assessments were performed at recovery and 1, 2 and 3 h thereafter. Fentanyl and buprenorphine were administered as rescue analgesics in the intra- and post-operative periods, respectively. Plasma magnesium concentrations did not increase after spinal injection compared to baseline. Group M required less intra-operative fentanyl, had lower Glasgow pain scores and experienced analgesia of longer duration than group C (527.0 ± 341.0 min vs. 176.0 ± 109.0 min). However, in group M the motor block was significantly longer, which limits the usefulness of magnesium for spinal analgesia at the investigated dose. Further research is needed to determine a clinically effective dose with shorter duration of motor block for magnesium used as an additive to spinal analgesic agents.

Topics: Amides; Analgesia; Analgesics; Analgesics, Opioid; Anesthetics, Local; Animals; Buprenorphine; Dogs; Fentanyl; Magnesium Sulfate; Osteotomy; Pain Measurement; Pain, Postoperative; Prospective Studies; Ropivacaine

To evaluate the influence of atipamezole on postoperative pain scores in cats.. Controlled, randomized, masked clinical trial.. Twelve healthy female domestic cats.. Cats admitted for ovariohysterectomy (OVH) surgery were randomly allocated to group atipamezole (n = 6) or group saline (n = 6) and were premedicated with buprenorphine 20 μg kg(-1) intramuscularly (IM) and alfaxalone 3.0 mg kg(-1) subcutaneously (SC). Anaesthesia was induced with alfaxalone intravenously (IV) to effect and maintained with isoflurane in oxygen. Ten minutes after extubation, cats from group atipamezole received IM atipamezole (0.0375 mg kg(-1) ) whereas group saline received an equivalent volume [0.0075 mL kg(-1) (0.003 mL kg(-1) IM)] of 0.9% saline. A validated multidimensional composite scale was used to assess pain prior to premedication and postoperatively (20 minutes after extubation). If postoperative pain scores dictated, rescue analgesia consisting of buprenorphine and meloxicam were administered. Pain score comparisons were made between the two groups using a Mann-Whitney exact test. Results are reported as the median and range.. Preoperatively, all cats scored 0. At the postoperative pain evaluation, the pain scores from group atipamezole [16 (range, 12-20)] were not significantly different from group saline [18 (range, 15-23)] (p = 0.28). All cats required rescue analgesia post-operatively.. Atipamezole (0.0375 mg kg(-1) IM) administration did not significantly affect the postoperative pain scores in cats after OVH. Preoperative administration of buprenorphine (20 μg kg(-1) IM) did not provide adequate postoperative analgesia for feline OVH.

Topics: Analgesia, Obstetrical; Analgesics, Opioid; Animals; Buprenorphine; Cats; Drug Interactions; Female; Hysterectomy; Imidazoles; Ovariectomy; Pain Measurement; Pain, Postoperative; Preanesthetic Medication; Pregnanediones

To determine the clinical effectiveness and safety of a compounded sustained-release formulation of buprenorphine, compared with effects of regular buprenorphine, for postoperative analgesia in rabbits.. Blinded randomized controlled clinical trial.. 24 purpose-bred adult male New Zealand White rabbits.. Rabbits received titanium implants in each tibia as part of another study. Immediately prior to surgery, each rabbit received regular buprenorphine hydrochloride (0.02 mg/kg [0.009 mg/lb], SC, q 12 h for 3 days) or 1 dose of a compounded sustained-release formulation of buprenorphine (0.12 mg/kg [0.055 mg/lb], SC) followed by an equal volume of saline (0.9% NaCl) solution (SC, q 12 h for 3 days) after surgery. For 7 days after surgery, rabbits were evaluated for signs of pain by means of rabbit grimace and activity scoring and for adverse effects.. No significant differences were identified between treatment groups in grimace and activity scores at any point. No major adverse effects were detected for either drug. However, 3 rabbits that received regular buprenorphine had pain scores suggestive of moderate to severe pain by the time dose administration was due (ie, within the 12-hour administration interval). No clinically important differences were detected in intraoperative anesthetic or postoperative recovery variables.. Sustained-release buprenorphine administered SC at 0.12 mg/kg was at least as effective as regular buprenorphine in providing analgesia for rabbits following orthopedic surgery without any major adverse effects. This sustained-release formulation represents an important alternative for rabbit analgesia with potential to improve rabbit welfare over existing analgesic standards.

Topics: Analgesics, Opioid; Animals; Buprenorphine; Delayed-Action Preparations; Male; Pain Measurement; Pain, Postoperative; Prostheses and Implants; Rabbits; Safety; Single-Blind Method; Tibia

For the hundreds of thousands of patients who undergo total knee arthroplasty (TKA) in the United States each year, early mobilization has been demonstrated to improve functional outcomes and reduce complications. Management of postoperative pain is a critical factor in achieving early mobilization. Recent studies have shown that the use of an adductor canal block (ACB) after TKA results in increased preservation of quadriceps muscle strength, without significant difference in postoperative pain when compared to femoral nerve block. This increased preservation of quadriceps muscle strength leads to earlier mobilization. Studies have also demonstrated a prolongation of analgesia with the addition of buprenorphine to local anesthetic for regional block placement. This study examined the effect on postoperative opioid consumption when adding buprenorphine to an ACB vs an ACB with local anesthetic alone, for postoperative analgesia after unilateral TKA.. A total of 100 patients scheduled for TKA were randomized to receive postoperative ACB with local anesthetic alone or with local anesthetic and buprenorphine. The primary outcome examined was total opioid analgesic (milligrams of hydrocodone equivalent) consumption in the first 24 hours postsurgery. The secondary outcomes examined were the reported incidence of the opioid side effects nausea, vomiting, and pruritis.. Postoperative opioid consumption decreased significantly in the group that received an ACB with local anesthetic and buprenorphine compared to an ACB with local anesthetic only (25.34±2.62 vs 35.84±2.86; P=.0076). Secondary outcomes showed no statistical difference between the 2 groups in terms of the incidence of nausea, vomiting, or pruritus.. The addition of buprenorphine to an adductor canal block decreases postoperative opioid consumption when compared to an ACB with local anesthetic alone. This reduction in opioid consumption, without significant increase in side effects, makes this an attractive anesthetic adjunct for TKA.

Topics: Aged; Analgesics, Opioid; Anesthesia, Local; Anesthetics, Local; Arthroplasty, Replacement, Knee; Buprenorphine; Female; Femoral Nerve; Humans; Male; Middle Aged; Muscle Strength; Nerve Block; Pain Measurement; Pain, Postoperative; Postoperative Nausea and Vomiting; Pruritus; Treatment Outcome

A number of trials have examined the peripheral analgesic effect of opioids, known to have an anti-nociceptive effect at the central and/or spinal cord level. This study aimed to evaluate the efficacy of buprenorphine added to 2% lignocaine with adrenaline 1:80,000 in providing postoperative analgesia after lower third molar surgery. Sixty patients were randomized to three groups: group A received lignocaine 2% with adrenaline 1:80,000 for inferior alveolar nerve block (IANB), along with intramuscular (IM) injection of 1ml saline; group B received buprenorphine mixed with lignocaine 2% with adrenaline 1:80,000 for IANB (0.01mg buprenorphine/ml lignocaine with adrenaline), along with 1ml saline IM; group C received lignocaine 2% with adrenaline 1:80,000 for IANB, along with 0.03mg buprenorphine IM. Mean postoperative pain scores (visual analogue scale; when the patient first felt pain) were 6.0 for group A, 1.0 for group B, and 4.4 for group C. The mean duration of postoperative analgesia was 3.5h in groups A and C and 12h in group B. The mean number of postoperative analgesics consumed was 5.8 in groups A and C and 3.9 in group B. The addition of buprenorphine (0.03mg) to 2% lignocaine with adrenaline 1:80,000 significantly reduced the severity of postoperative pain and prolonged the duration of analgesia, thereby decreasing the need for postoperative analgesics.

Topics: Adult; Analgesia; Analgesics, Opioid; Anesthetics, Local; Buprenorphine; Double-Blind Method; Epinephrine; Female; Humans; Lidocaine; Male; Molar, Third; Pain, Postoperative; Tooth Extraction

Neonates undergoing surgery require analgesic medication to ameliorate acute pain. These medications produce negative side effects. Docosahexaenoic acid (DHA) has an antinociceptive effect in animals, but this has not been evaluated in human neonates. We evaluated the DHA effect on cumulative dose and duration of analgesics administered to neonates undergoing cardiovascular surgery.. A secondary analysis was performed with data from a clinical trial, in which enteral DHA was administered perioperatively compared with sunflower oil (SO). Present study assessed the antinociceptive effect of DHA by measuring the cumulative dose and duration of analgesics administered during postoperative stay in a neonatal intensive care unit. Multivariate linear regression models were performed.. Seventeen neonates received DHA and 18 received SO in the control group. Compared with the control group, the DHA group received lower cumulative dose (14.6 ± 2.2 vs. 25.2 ± 4.8 μg/kg, p = 0.029) and shorter duration of buprenorphine (2 days (1-8) vs. 4.5 days (1-12); p = 0.053). After adjusting for confounders, the DHA group received significantly lesser buprenorphine (β = -27 μg/kg, p = 0.028; R2 model = 0.90) for shorter duration (β = -9 days, p = 0.003; R2 model = 0.94). No differences in fentanyl or ketorolac were detected.. Buprenorphine administration was reduced in neonates who received DHA, suggesting that DHA likely has analgesic effects.

Topics: Acute Pain; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Aorta; Blalock-Taussig Procedure; Buprenorphine; Cardiovascular Abnormalities; Dietary Supplements; Docosahexaenoic Acids; Double-Blind Method; Female; Follow-Up Studies; Hospitals, Pediatric; Humans; Infant Nutritional Physiological Phenomena; Infant, Newborn; Intensive Care Units, Neonatal; Male; Mexico; Pain, Postoperative; Perioperative Care; Time Factors

The aim of this study was to evaluate the analgesic effects of maxillary and/or inferior alveolar nerve blocks with lidocaine and bupivacaine in cats undergoing dental extractions. Twenty-nine cats were enrolled. Using an adapted composite pain scale, cats were pain scored before the dental procedure and 30 mins, and 1, 2 and 4 h after isoflurane disconnection. Cats were sedated with buprenorphine (20 µg/kg), medetomidine (10 µg/kg) and acepromazine (20 µg/kg) intramuscularly. Anaesthesia was induced using alfaxalone (1-2 mg/kg) intravenously and maintained with isoflurane in oxygen. Each cat was randomly assigned to receive maxillary and/or inferior alveolar nerve blocks or no nerve blocks prior to dental extractions. Each nerve block was performed using lidocaine (0.25 mg/kg) and bupivacaine (0.25 mg/kg). Heart rate, systolic arterial blood pressure, respiratory rate, end tidal carbon dioxide and isoflurane vaporiser settings were recorded 5 mins before and after the dental extractions, and the difference calculated. Group mean differences (mean ± SD) for heart rate (-9.7 ± 10.6 vs 7.6 ± 9.5 beats/min [nerve block vs control group, respectively], P <0.0001), systolic arterial blood pressure (-10.33 ± 18.44 vs 5.21 ± 15.23 mmHg, P = 0.02) and vaporiser settings (-0.2 ± 0.2 vs 0.1 ± 0.4, P = 0.023) were significantly different between groups. The control group had higher postoperative pain scores (median [interquartile range]) at 2 h (3 [1.75-4.00] vs 1 [0-2], P = 0.008) and 4 h (4 [2-6] vs 2 [1-2], P = 0.006) after the dental extractions. Maxillary and inferior alveolar nerve blocks with lidocaine and bupivacaine administered prior to dental extractions resulted in a reduction in heart rate and blood pressure while allowing for a reduction in isoflurane. Cats receiving nerve blocks had lower postoperative pain scores than the group without nerve blocks.

Topics: Anesthesia, Dental; Animals; Bupivacaine; Buprenorphine; Cat Diseases; Cats; Isoflurane; Lidocaine; Medetomidine; Nerve Block; Pain, Postoperative; Preanesthetic Medication; Pregnanediones; Tooth Extraction

The aim of the study was to determine whether the addition the long-acting opioid buprenorphine as an adjuvant to the local anaesthetic agent would improve quality and prolong duration of femoral nerve blockade in post-operative analgesia following primary total knee arthroplasty. The study involved 48 patients. The femoral nerve was anaesthetised with a 0.25% solution of bupivacaine with adrenaline or with the addition of 0.3mg of buprenorphine. The duration of the sensory block and analgesic effect was assessed according to NRS scale at 12, 24, 36, 48, 60 and 72 hours post-surgery. Patients who received buprenorphine as an adjuvant to the local anaesthetic had significantly longer sensory blockade and lower NRS-rated pain intensity with the difference reaching statistical significance at 12 hours post-surgery.

Topics: Aged; Analgesics; Arthroplasty, Replacement, Knee; Bupivacaine; Buprenorphine; Double-Blind Method; Female; Femoral Nerve; Humans; Male; Middle Aged; Nerve Block; Pain Measurement; Pain, Postoperative; Prospective Studies; Time Factors

Most models of acute post-operative orthopedic pain involve the injection of a clinically irrelevant pro-inflammatory agent. The ideal model should, however, be clinically relevant and allow full functional recovery of enrolled animals after research is completed. This study explored the validity of a model employing arthrotomy and objectively measured limb use. Six purpose-bred Beagles underwent arthrotomies on each stifle with a washout period in between. Using a randomized crossover design, each dog received placebo and an extended-release buprenorphine (ER-Bup) preparation. Static and dynamic ground reaction forces (GRFs) were measured prior to and for 72 h following surgery using a pressure sensitive walkway (PSW). GRFs for each hind limb were compared using difference (delta), and symmetry indices (SI). The effects of surgery and of treatment were analyzed using repeated measures ANCOVA. The results indicated significantly decreased limb use compared to baseline for placebo, and significantly increased limb use in the ER-Bup group over placebo at all times for % bodyweight distribution (%BWdistrib), peak vertical force (PVF) and vertical impulse (VI). There was a significant treatment by time interaction for velocity (P = 0.03) and %BWdistrib (P = 0.01, 0.003). Overall, the data show that reduced limb use was present for at least 72 h following arthrotomy. In addition, the use of the ER-Bup analgesic decreased lameness, confirming the validity of this approach as a model of post-operative pain. Subjective assessments did not detect the pain-inducing effects of arthrotomy or pain-alleviating effects of treatment, and subjective measures of procedural pain in research dogs need to be developed.

Topics: Analgesics, Opioid; Animals; Buprenorphine; Cross-Over Studies; Delayed-Action Preparations; Dogs; Male; Orthopedic Procedures; Pain Measurement; Pain, Postoperative; Stifle

Anesthetics may influence adrenal function and consequently alter serum glucocorticoid concentrations, leading to erroneous interpretations of results from anesthetized rabbits. However, decreases in glucocorticoid concentrations may be advantageous in protocols designed to minimize the stress response to surgery. This study characterized the variations in adrenocortical function based on changes in corticosterone and cortisol levels after various doses and combinations of dexmedetomidine, ketamine, and buprenorphine. Each rabbit received all treatments with a minimal interexperiment interval of 10 d. Rabbits were allocated to 7 groups (n = 10 per group) and received either 1 mL saline solution; dexmedetomidine at 0.05, 0.15, or 0.25 mg/kg; ketamine (35 mg/kg) and dexmedetomidine (0.25 mg/kg) without or with buprenorphine (0.03 mg/kg); or ketamine (35 mg/kg) and buprenorphine (0.03 mg/kg). Blood was sampled before drug administration and at 10, 30, 60, and 120 min and 24 h afterward. Serum glucocorticoid levels fell in all treatment groups except the one receiving ketamine-dexmedetomidine; in that group, serum glucocorticoids increased. Rabbits that received ketamine-dexmedetomidine-buprenorphine had the lowest serum glucocorticoid levels overall. In conclusion, dexmedetomidine reduces glucocorticoid secretion in rabbits but, when combined with ketamine, increases corticosterone and cortisol levels as well as heart and respiratory rates. The addition of buprenorphine to the ketamine-dexmedetomidine mixture reduces serum glucocorticoid levels. The influence of anesthetic drugs should be considered when designing a protocol to minimize the glucocorticoid response to surgery or when measuring glucocorticoid levels in rabbits.

Topics: Anesthetics; Animals; Buprenorphine; Dexmedetomidine; Drug Therapy, Combination; Female; Hydrocortisone; Ketamine; Pain, Postoperative; Rabbits

To compare the analgesic effects of buprenorphine and butorphanol in domestic cats.. 2-phase positive-controlled randomized masked clinical trial.. 39 healthy female cats (10 in phase 1 and 29 in phase 2).. Cats admitted for ovariohysterectomy received buprenorphine (4 in phase 1; 14 in phase 2) or butorphanol (6 in phase 1; 15 in phase 2). In phase 1, cats were premedicated with buprenorphine (0.02 mg/kg [0.009 mg/lb], IM) or butorphanol (0.4 mg/kg [0.18 mg/lb], IM), in combination with medetomidine. Anesthesia was induced with propofol (IV) and maintained with isoflurane in oxygen. After extubation, medetomidine was antagonized with atipamezole. A validated multidimensional composite scale was used to assess signs of pain after surgery starting 20 minutes after extubation and continuing for up to 360 minutes, and pain score comparisons were made between the 2 groups. Phase 2 proceeded similar to phase 1 with the following addition: during wound closure, cats from the butorphanol and buprenorphine groups received butorphanol (0.4 mg/kg, IM) or buprenorphine (0.02 mg/kg, IM), respectively.. Phase 1 of the study was stopped after 10 cats were ovariohysterectomized because 9 of 10 cats required rescue analgesia at the first evaluation. In phase 2, at the first pain evaluation, pain scores from the buprenorphine group were lower, and all cats from the butorphanol group required rescue analgesia. None of the cats from the buprenorphine group required rescue analgesia at any time.. Buprenorphine (0.02 mg/kg, IM) given before surgery and during wound closure provided adequate analgesia for 6 hours following ovariohysterectomy in cats, whereas butorphanol did not.

Topics: Analgesics, Opioid; Animals; Buprenorphine; Butorphanol; Cat Diseases; Cats; Female; Hysterectomy; Ovariectomy; Pain, Postoperative; Perioperative Period

The aim of this study was to compare the postoperative analgesic effects of robenacoxib and buprenorphine alone or in combination, in cats after ovariohysterectomy. Thirty healthy cats were randomly assigned to receive buprenorphine (0.02 mg/kg, n=10; GB), robenacoxib (2mg/kg, n=10; GR) or their combination at the same dosages (n=10; GBR) SC. After 30 min cats were sedated with an IM administration of medetomidine (0.02 mg/kg) and ketamine (5mg/kg). General anaesthesia was induced with propofol and after intubation was maintained with isoflurane. Before premedication and at 1, 2, 3, 4, 6, 8, 12 and 24h after extubation, pain and sedation were assessed using a simple descriptive pain scale, ranging from 0 (no pain/no sedation) to 4 (intense pain/ deep sedation). If the pain score was ≥ 3, rescue analgesia was provided using buprenorphine (0.02 mg/kg) administered IM. Pain score was higher in GB at 2, 3, 4, 6 and 8h compared to baseline and compared to GBR at the same study times. Moreover, the pain score was also higher in GB compared to GR at 2, 3, 4 and 6h. Pain score was similar at all study times between GR and GBR. Sedation at 1 and 2h was higher than baseline values in all groups. Cats in GB received rescue analgesia more often than cats assigned to GR or GBR. Robenacoxib was an effective analgesic drug in cats up to 24h after ovariohysterectomy. The addition of buprenorphine did not provide any additional analgesic effects compared to robenacoxib alone.

Topics: Analgesics; Animals; Buprenorphine; Cat Diseases; Cats; Diphenylamine; Drug Therapy, Combination; Hysterectomy; Ovariectomy; Pain, Postoperative; Phenylacetates

The objective of this study was to compare the postoperative analgesic effects of dexketoprofen, tramadol, and buprenorphine in dogs undergoing ovariohysterectomy. Seventy-five adult female dogs were randomly assigned to receive an intravenous injection (IV) of 1mg/kg of dexketoprofen (D), 0.02 mg/kg of buprenorphine (B) or 2mg/kg of tramadol (T). Pain assessment was performed during 48 h after ovariohysterectomy using a dynamic interactive visual analogue scale (DIVAS) and Glasgow composite measure pain scale (CMPS-SF). Rescue analgesia was required in 43%, 21%, and 5% of dogs in the B, T, and D groups, respectively, with significant differences between B and D (p=0.010) groups. The DIVAS and CMPS-SF values of the B group were significantly higher than those of the T and D groups. The most common undesirable effect was dysphoria in dexketoprofen group. Tramadol and dexketoprofen provide superior postoperative analgesia compared with buprenorphine in dogs undergoing ovariohysterectomy.

Topics: Analgesia; Analgesics, Opioid; Animals; Buprenorphine; Dogs; Female; Hysterectomy; Injections, Intravenous; Ketoprofen; Ovariectomy; Pain Measurement; Pain, Postoperative; Random Allocation; Statistics, Nonparametric; Tramadol

Buprenorphine has recently obtained UK Marketing Authorisation for horses. The analgesic effects are long lasting, and have considerable potential for postoperative pain relief. This observer blinded, randomised study aimed to evaluate postsurgical analgesia in ponies premedicated with buprenorphine prior to castration under intravenous anaesthesia. Ponies received either 0.01 mg/kg bodyweight (BW) buprenorphine (group B) or an equivalent volume of 5 per cent glucose (group C) given intravenously before induction of anaesthesia. Pain was assessed and recorded using dynamic interactive visual analogue scores (DIVAS 0-100) and a Simple Descriptive Scale (SDS 0-3) (high scores=most pain) before and 1, 3, 6, 9, 12 and 24 hours after anaesthesia. Rescue analgesia was given if DIVAS>40 mm. Data were analysed using the Mann-Whitney U test at P<0.05. Median (range) areas under the curve for DIVAS were 63 (0-383) mm hour in group B and 209 (0-391) mm hour in group C (P=0.0348). The SDS was lower in group B than in group C (P=0.038). Three group B and five group C animals required rescue analgesia. Buprenorphine did not produce any serious adverse effects. Buprenorphine at 0.01 mg/kg BW intravenously administered before anaesthesia provided near-comprehensive postoperative analgesia after surgical castration in ponies.

Topics: Analgesics, Opioid; Animals; Buprenorphine; Dose-Response Relationship, Drug; Horses; Injections, Intravenous; Male; Orchiectomy; Pain, Postoperative; Treatment Outcome

Management of pain in research swine used for studies involving painful procedures is a considerable challenge. Here we assessed whether a regional anesthesia method is effective for pain control of hindlimb injuries in pigs used for research in bone fracture healing. For this randomized controlled study, we administered regional anesthesia before an experimental femoral injury was produced. Using ultrasound guidance, we placed sterile infusion catheters near the sciatic and femoral nerves and administered local anesthetic (bupivacaine) for the first 24 h after surgery. We evaluated various behavioral and physiologic parameters to test the hypothesis that this regional anesthesia would provide superior analgesia compared with systemic analgesia alone. We also collected blood samples to evaluate serum levels of cortisol and fentanyl postoperatively. At the end of the study period, we collected sciatic and femoral nerves and surrounding soft tissues for histopathologic evaluation. Treatment pigs had lower subjective pain scores than did control animals. Control pigs had a longer time to first feed consumption and required additional analgesia earlier in the postoperative period than did treatment pigs. Ultrasound-guided regional anesthesia is a viable and effective adjunct to systemic analgesics for providing pain control in swine with experimental femoral fractures.

Topics: Analgesics; Anesthetics, Local; Animals; Bupivacaine; Buprenorphine; Catheters; Female; Femoral Fractures; Femoral Nerve; Fentanyl; Pain, Postoperative; Sciatic Nerve; Swine; Ultrasonography

The effects of constant rate infusion (CRI) of lidocaine on sevoflurane (SEVO) requirements, autonomic responses to noxious stimulation, and postoperative pain relief were evaluated in dogs undergoing opioid-based balanced anesthesia. Twenty-four dogs scheduled for elective ovariectomy were randomly assigned to one of four groups: BC, receiving buprenorphine without lidocaine; FC, receiving fentanyl without lidocaine; BL, receiving buprenorphine and lidocaine; FL, receiving fentanyl and lidocaine. Dogs were anesthetized with intravenous (IV) diazepam and ketamine and anesthesia maintained with SEVO in oxygen/air. Lidocaine (2mg/kg plus 50 μg/kg/min) or saline were infused in groups BL/FL and BC/FC, respectively. After initiation of lidocaine or saline CRI IV buprenorphine (0.02 mg/kg) or fentanyl (4 μg/kg plus 8 μg/kg/h CRI) were administered IV in BC/BL and FC/FL, respectively. Respiratory and hemodynamic variables, drug plasma concentrations, and end-tidal SEVO concentrations (E'SEVO) were measured. Behaviors and pain scores were subjectively assessed 1 and 2h post-extubation. Lidocaine CRI produced median drug plasma concentrations <0.4 μg/mL during peak surgical stimulation. Lidocaine produced a 14% decrease in E'SEVO in the BL (P<0.01) but none in the FL group and no change in cardio-pulmonary responses to surgery or postoperative behaviors and pain scores in any group. Thus, depending on the opioid used, supplementing opioid-based balanced anesthesia with lidocaine (50 μg/kg/min) may not have any or only a minor impact on anesthetic outcome in terms of total anesthetic dose, autonomic responses to visceral nociception, and postoperative analgesia.

Topics: Analgesia; Analgesics, Opioid; Anesthetics, Inhalation; Anesthetics, Intravenous; Anesthetics, Local; Animals; Balanced Anesthesia; Buprenorphine; Dogs; Female; Fentanyl; Infusions, Intravenous; Lidocaine; Methyl Ethers; Ovariectomy; Pain, Postoperative; Prospective Studies; Sevoflurane; Single-Blind Method

One hundred female cats undergoing routine ovariohysterectomy under midazolam-medetomidine-ketamine anaesthesia were included in a blinded, randomised, prospective clinical study to compare postoperative analgesia produced by four analgesic drug combinations given preoperatively (n = 25 per group). A secondary aim was to assess the effects in kittens and pregnant animals. Buprenorphine 180 µg/m(2) or butorphanol 6 mg/m(2) were given with either carprofen 4 mg/kg (groups BUPC and BUTC, respectively) or meloxicam 0.3 mg/kg (groups BUPM or BUTM, respectively). Medetomidine was not antagonised. A simple, descriptive scale (SDS; 0-4), a dynamic and interactive visual analogue scale (DIVAS; 0-100 mm) and mechanical nociceptive thresholds (MT; 2.5-mm diameter probe) were used to evaluate postoperative pain. All pain scores were low (DIVAS <10 mm, SDS <2 and MT >10 N) and there were no significant differences between the groups. It was concluded that all protocols provided adequate analgesia and when used with midazolam-medetomidine-ketamine are effective for routine feline ovariohysterectomy.

Topics: Analgesics, Opioid; Anesthesia, Obstetrical; Anesthetics, Combined; Animals; Behavior, Animal; Buprenorphine; Carbazoles; Cat Diseases; Cats; Double-Blind Method; Female; Humans; Hysterectomy; Meloxicam; Ovariectomy; Pain, Postoperative; Postoperative Care; Pregnancy; Premedication; Prenatal Exposure Delayed Effects; Prospective Studies; Thiazines; Thiazoles; Time Factors; Treatment Outcome

The aim of this study was to assess whether addition of epineural buprenorphine prolonged postoperative analgesia of middle interscalene brachial plexus block (MIB) with levobupivacaine.. One hundred and fifty consenting adult patients, scheduled for shoulder arthroscopic surgery for a rotator cuff tear under MIB with 29.5 ml of 0.75 % levobupivacaine, were randomized to receive additionally either saline or intramuscular buprenorphine 0.15 mg or epineural buprenorphine 0.15 mg. Onset of sensory and motor blocks, duration of postoperative analgesia, and consumption of postoperative analgesics were compared among the groups.. There were significant (P < 0.05) differences in the onset and the duration of the sensory block and in the duration of postoperative analgesia. Duration of both sensory block and postoperative analgesia was longer (P < 0.05) in patients who had received epineural buprenorphine (856.1 ± 215.2 and 1,049.7 ± 242.2 min) than in patients who had received intramuscular buprenorphine (693.6 ± 143.4 and 820.3 ± 335.3 min) or saline (488.3 ± 137.6 and 637.5 ± 72.1 min). Requirement of postoperative rescue analgesics was lower in the epineural buprenorphine group than in the other two groups. Few complications occurred from MIB (<1 %) and none from buprenorphine.. Epineural buprenorphine prolonged postoperative analgesia of MIB more effectively than intramuscular buprenorphine, which suggests that buprenorphine acts at a peripheral nervous system site of action.

Topics: Analgesics, Opioid; Arthroscopy; Brachial Plexus; Bupivacaine; Buprenorphine; Double-Blind Method; Drug Synergism; Female; Humans; Levobupivacaine; Male; Middle Aged; Nerve Block; Pain Measurement; Pain, Postoperative

A prospective, double-blinded, positive-controlled, multicenter, noninferiority clinical study was conducted to evaluate the safety and effectiveness of a long-acting transdermal fentanyl solution (TFS) for the control of postoperative pain. Four hundred forty-five client-owned dogs of various breeds were randomly assigned to receive a single dose of TFS (2.6 mg/kg [∼50 μL/kg]) (N = 223) applied 2-4 h prior to surgery or buprenorphine (20 μg/kg) (N = 222) administered intramuscularly 2-4 h prior to surgery and every 6 h through 90 h. There were 159 (35.7%) males and 286 (64.3%) females ranging from 0.5 to 16 years of age and 3 to 98.5 kg enrolled. Pain was scored using the modified Glasgow Composite Pain Scale with an a priori dropout criteria of ≥ 8 (20 maximum score). The one-sided upper 95% confidence interval of the mean difference between fentanyl and buprenorphine treatment failures was 5.6%, which was not greater than the a priori selected margin difference of 15%. Adverse events attributed to either treatment were minimal in impact and were approximately equal between groups. Sustained plasma fentanyl concentrations provided by a single pre-emptive dose of TFS are safe and effective and are noninferior to repeated injections of buprenorphine in controlling postoperative pain over 4 days. This long-acting fentanyl formulation provides veterinarians with a novel, registered option for the control of postoperative pain in dogs that improves dosing compliance and potentially mitigates the disadvantages of oral, parenteral, and patch delivered opioids.

Topics: Administration, Cutaneous; Analgesics, Opioid; Animals; Buprenorphine; Delayed-Action Preparations; Dog Diseases; Dogs; Double-Blind Method; Female; Fentanyl; Male; Pain, Postoperative; Solutions; Surgical Procedures, Operative; Weight Loss

Although numerous methods are available for postoperative pain (POP) management, new approaches are constantly being investigated. This feasibility study assessed the buprenorphine transdermal therapeutic system (Bup-TTS) for the treatment of POP after gynecological open surgery.. Forty-five patients were prospectively randomized to different Bup-TTS dosages (17.5, 35, or 52.5 μg/h). Patients were blinded with regard to patch dose.. Efficacy was evaluated in terms of rescue boluses (intravenous morphine 2 mg in the first six postoperative hours, intravenous ketorolac 30 mg thereafter) required to achieve a static and dynamic Numerical Rating Scale (sNRS and dNRS) score ≤4. Side effects were evaluated from patch application (12 hours before surgery) until the 72nd postoperative hour. Patient satisfaction regarding POP management was assessed via anonymous questionnaire.. All Bup-TTS groups required additional postoperative analgesia, particularly in the first postoperative hour. No between-group differences in sNRS/dNRS values were recorded at emergence from anesthesia. A significant inverse correlation occurred between Bup-TTS dosage and use of morphine (p = 0.04), ketorolac (p = 0.04) or both rescues (p = 0.02). Postoperative nausea/vomiting occurred in 3.1% of assessments, with no between-group differences and a significant correlation with morphine amount (p = 0.01). No serious side effects occurred. Despite no between-group difference, patient satisfaction was inversely correlated with the number of rescue doses (p < 0.001). Study limitations include the small sample size, the absence of a control group treated with a more conventional technique for POP relief, the focus on selected patients at low perioperative risk and the presence of slightly different types of open surgery (hysterectomy vs myomectomy only).. Bup-TTS efficacy was directly proportional to its dosage, although additional analgesia was required, particularly in the first postoperative hour. Moreover, the consumption of morphine and ketorolac was inversely correlated to the Bup-TTS dosage. Increasing Bup-TTS doses were not associated with an increased incidence of side effects. Bup-TTS appears a safe and feasible approach for moderate POP management; further larger studies are warranted.

Topics: Administration, Cutaneous; Adult; Aged; Analgesics, Opioid; Buprenorphine; Female; Gynecologic Surgical Procedures; Humans; Middle Aged; Pain Management; Pain, Postoperative; Prospective Studies

Buprenorphine is commonly used as (part of) postoperative analgesic treatment with dosage dependent side-effects such as pica behaviour. No strict consensus exists about the optimal dosing interval of buprenorphine, as its duration of action has been described as being in the range of 6-12 h. In this study, dosing intervals of 8 h (thrice-a-day) and 12 h (twice-a-day) for buprenorphine in a multimodal analgesic strategy (concurrent administration of a non-steroidal anti-inflammatory drug) were compared on food intake, weight and side-effects (gnawing on plastic Petri dishes and growth rate, indicative of pica behaviour) in rats. The food intake and weight of both intervals were comparable, as the animals from the twice-a-day group did not lose more weight or consumed less food during the analgesic period. The rats from the thrice-a-day group suffered from more side-effects, as the growth rate was decreased and more plastic was gnawed on. It is recommended to carefully evaluate analgesic and side-effects when using buprenorphine. When side-effects are observed, the possibility of increasing the dosing interval of buprenorphine should be explored. In this study, increasing the dosing interval of buprenorphine in a multimodal analgesic regimen resulted in reduced unwanted side-effects, without increasing weight loss or decreasing food intake. Although this is suggestive of provision of comparable analgesia, future studies including more pain-related readout parameters to assess the effect of the dosing interval on analgesic efficacy are recommended.

Topics: Analgesics, Opioid; Animals; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Drug Therapy, Combination; Electrodes, Implanted; Feeding Behavior; Injections, Subcutaneous; Male; Meloxicam; Neurosurgical Procedures; Pain, Postoperative; Pica; Postoperative Care; Rats; Rats, Wistar; Thiazines; Thiazoles; Time Factors; Weight Gain

To compare the efficacy of preoperative administration of buprenorphine (via oral transmucosal [OTM] and IV routes) for postoperative analgesia in dogs undergoing ovariohysterectomy.. Prospective, randomized, blinded study.. 18 dogs undergoing routine ovariohysterectomy.. Dogs were allocated to 3 groups (6 dogs/group) and were assigned to receive buprenorphine (20 μg/kg [9.09 μg/lb], IV; a low dose [20 μg/kg] via OTM administration [LOTM]; or a high dose [120 μg/kg [54.54 μg/lb] via OTM administration [HOTM]) immediately before anesthetic induction with propofol and maintenance with isoflurane for ovariohysterectomy. Postoperative pain was assessed by use of a dynamic interactive pain scale. Dogs were provided rescue analgesia when postoperative pain exceeded a predetermined threshold. Blood samples were collected, and liquid chromatography-electrospray ionization-tandem mass spectrometry was used to determine plasma concentrations of buprenorphine and its metabolites. Data were analyzed with an ANOVA.. Body weight, surgical duration, propofol dose, isoflurane concentration, and cardiorespiratory variables did not differ significantly among treatment groups. Number of dogs requiring rescue analgesia did not differ significantly for the HOTM (1/6), IV (3/6), and LOTM (5/6) treatments. Similarly, mean ± SEM duration of analgesia did not differ significantly for the HOTM (20.3 ± 3.7 hours), IV (16.0 ± 3.8 hours), and LOTM (7.3 ± 3.3 hours) treatments. Plasma buprenorphine concentration was ≤ 0.60 ng/mL in 7 of 9 dogs requiring rescue analgesia.. Buprenorphine (HOTM) given immediately before anesthetic induction can be an alternative for postoperative pain management in dogs undergoing ovariohysterectomy.

Topics: Administration, Oral; Analgesics; Animals; Buprenorphine; Dog Diseases; Dogs; Female; Hysterectomy; Injections, Intravenous; Ovariectomy; Pain, Postoperative; Time Factors

Comparison of the analgesic effect of buprenorphine at 20 or 40 μg kg(-1) .. An investigator 'blinded', randomised study.. Twenty six dogs presented for ovariohysterectomy.. Dogs were premedicated intramuscularly with acepromazine 0.03 mg kg(-1) and buprenorphine at either 20 (B20, n = 12) or 40 μg kg(-1) (B40, n = 14) followed by anaesthetic induction with propofol and maintenance with isoflurane. During anaesthesia non invasive blood pressure, heart rate, respiratory rate, blood oxygen saturation, inspired and expired volatile agent, end-tidal carbon dioxide and ECG were recorded. Pain and sedation were assessed using interactive VAS scores; mechanical nociceptive thresholds were measured at the wound and hindlimb--all were assessed before and up to 22 hours after administration. Carprofen was used for rescue analgesia.. There were no significant differences between the two groups for any of the parameters examined. Rescue analgesia was required around 5 hours after administration of buprenorphine in a significant number of animals. Sedation was good preoperatively and scores decreased over time postoperatively. Hock thresholds did not change over time; wound thresholds decreased significantly compared to the baseline value from 3 hours onwards.. Administration of buprenorphine at either 20 or 40 μg kg(-1) IM with acepromazine provided good pre-operative sedation. Cardiovascular and respiratory values remained within clinically acceptable limits during anaesthesia. There was no evidence that increasing dose increased adverse events that may be associated with opioid administration (e.g. bradycardia and respiratory depression).. Increasing the dose of buprenorphine from 20 to 40 μg kg(-1) did not provide any benefits with respect to analgesia after ovariohysterectomy as assessed using the VAS scoring system.

Topics: Acepromazine; Analgesics, Opioid; Animals; Buprenorphine; Dogs; Dose-Response Relationship, Drug; Female; Hypnotics and Sedatives; Hysterectomy; Ovariectomy; Pain Measurement; Pain, Postoperative; Premedication; Single-Blind Method; Treatment Outcome

One hundred and fifty-three cats undergoing surgery in seven veterinary practices in Great Britain were studied. They were randomly allocated to receive either 10-20 microg/kg buprenorphine or 0.4 mg/kg butorphanol with acepromazine before anaesthesia with propofol, Saffan or thiopentone and isoflurane or halothane. Routine monitoring was undertaken. Pain and sedation were assessed blind using a four point (0-3) simple descriptive scale (SDS) at 1, 2, 4, 8 and 24h. Pain and sedation data were compared using non-parametric statistical tests and continuous data using t tests or analysis of variance (ANOVA). Anaesthesia and surgery were uneventful, and cardiorespiratory data were within normal limits. After surgery, overall, more cats had pain score 0 after buprenorphine and more had pain score 3 after butorphanol (P=0.0465). At individual time points, more cats had lower pain scores after buprenorphine at 2 (P=0.040) and 24 (P=0.036)h. At 24h 83% after buprenorphine and 63% after butorphanol had pain score 0 (P<0.04). Buprenorphine provided better and longer lasting postoperative analgesia than butorphanol.

Topics: Analgesics, Opioid; Analysis of Variance; Animals; Buprenorphine; Butorphanol; Cats; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Male; Pain Measurement; Pain, Postoperative; Postoperative Care; Prospective Studies; Treatment Outcome

Results from previous studies have shown favorable effects from the addition of buprenorphine to local anesthetics used for interscalene or axillary perivascular brachial plexus blocks. The main objective of the current study was to determine whether addition of buprenorphine could enhance bupivacaine analgesia after infragluteal sciatic nerve block.. One hundred and three consenting adult patients for elective foot and ankle outpatient surgeries were prospectively assigned randomly, in double-blind fashion, to one of three groups. Group 1 received 0.5% bupivacaine with epinephrine 1:200,000 for infragluteal sciatic block plus 1 ml normal saline intramuscularly. Group 2 received bupivacaine sciatic block along with intramuscular buprenorphine (0.3 mg). Group 3 received bupivacaine plus buprenorphine for infragluteal sciatic block and 1 ml normal saline intramuscularly.. Although patients receiving buprenorphine either for sciatic block or intramuscularly had less pain in the postanesthesia care unit compared with patients receiving only bupivacaine, the individual pair-wise comparison of the analysis of variance model showed no statistical difference. However, only buprenorphine added to bupivacaine for sciatic block prolonged postoperative analgesia. Patients receiving a combination of buprenorphine and bupivacaine for sciatic block had lower numeric rating pain scores and received less opioid medication at home than patients in the other two groups.. The results show that buprenorphine may enhance and prolong the analgesic effect of bupivacaine when used for sciatic nerve blocks in patients undergoing foot and ankle surgery under general anesthesia but does not do so to the extent shown in previous studies using brachial plexus models with mepivacaine and tetracaine.

Topics: Adult; Ambulatory Surgical Procedures; Analgesics, Opioid; Anesthetics, Local; Ankle; Bupivacaine; Buprenorphine; Double-Blind Method; Female; Foot; Humans; Injections, Intramuscular; Male; Middle Aged; Nerve Block; Orthopedic Procedures; Pain Measurement; Pain, Postoperative; Patient Satisfaction; Postoperative Nausea and Vomiting; Preanesthetic Medication; Sciatic Nerve; Treatment Outcome

To evaluate the analgesic properties of transdermally administered fentanyl and IM administered buprenorphine in sheep undergoing unilateral tibial osteotomy.. 20 mature sheep.. Fentanyl patches (n = 15 sheep) or placebo patches (5 sheep) were applied 12 hours before sheep underwent general anesthesia and a unilateral tibial osteotomy. Buprenorphine was administered to the placebo group every 6 hours commencing at time of induction. Signs of pain were assessed every 12 hours after surgery by 2 independent observers unaware of treatment groups.. There were no differences in preoperative and intraoperative physiologic data between the 2 groups. Sheep treated with fentanyl required less preoperative administration of diazepam for sedation and had significantly lower postoperative pain scores, compared with those treated with buprenorphine. No complications associated with the antebrachium at the site of patch application were detected.. Under the conditions of this study, transdermally administered fentanyl was a superior option to IM administered buprenorphine for alleviation of postoperative orthopedic pain in sheep. This information can be used to assist clinicians in the development of a rational analgesic regimen for research and clinical patients.

Topics: Administration, Cutaneous; Analgesics; Animals; Buprenorphine; Drug Administration Schedule; Female; Fentanyl; Injections, Intramuscular; Orthopedic Procedures; Pain, Postoperative; Sheep

Eighty-four female cats undergoing ovariohysterectomy in a blinded, randomised, prospective clinical study were assigned to one of three groups of 28 to receive either 0.01 mg/kg buprenorphine (group B), 4 mg/kg carprofen (group C), or the same doses of both drugs (group BC). A dynamic and interactive visual analogue scale (DIVAS) from 0 to 100 mm, and a simple descriptive scale (SDS) from 0 to 4 were used to evaluate the cats' degree of analgesia and sedation for 24 hours postoperatively. There was no significant difference in the cats' sedation scores by SDS or DIVAS, and no difference in their pain scores by DIVAS. By SDS, the cats in group BC had significantly lower pain scores than the cats in group C (P<0.001) and group B (P<0.05). Nine of the cats in group B, nine in group C and five in group BC required rescue analgesia, and the cats in group C required rescue earlier than those in group B (P<0.05).

Topics: Analgesics, Opioid; Anesthesia, General; Animals; Anti-Inflammatory Agents, Non-Steroidal; Behavior, Animal; Buprenorphine; Carbazoles; Cats; Drug Therapy, Combination; Female; Hysterectomy; Ovariectomy; Pain Measurement; Pain, Postoperative; Prospective Studies; Time Factors; Treatment Outcome

Intense pain in the first 12 hours after major abdominal surgery requires the use of large amounts of analgesics, mainly opioids, which may produce undesirable effects. Buprenorphine (BUP) is not typically used intravenously in this setting, particularly in combination with morphine (MO), due to concerns that BUP might inhibit the analgesic effect of MO.. This study compared the analgesic effect of BUP and MO separately and in combination for postoperative pain control in patients undergoing abdominal surgery.. In this double-blind study, adult patients were randomized to receive 1 of 4 regimens for 12 hours: a basal BUP infusion (BUP-i) of 0.4 microg/kg/h + BUP boluses (BUP-b) of 0.15 microg/kg each; a basal MO infusion (MO-i) of 10 microg/kg/h + MO boluses (MO-b) of 5 microg/kg each; a basal BUP-i of 0.4 microg/kg/h + MO-b of 5 microg/kg each; or a basal MO-i of 10 microg/kg/h + BUP-b of 0.15 microg/kg each. Bolus doses were delivered by intravenous patient-controlled anesthesia, with a bolus lockout time of 7 minutes. Diclofenac 75 mg IM q6h was available as rescue pain medication. Every 15 minutes during the first 2 postoperative hours and hourly thereafter, patients used visual analog scales to rate their pain (from 0 = totally free of pain to 10 = unbearable pain), level of sedation (from 1 = totally awake to 10 = heavily sedated), and satisfaction with treatment (from 1 = totally unsatisfied to 10 = fully satisfied). Blood pressure, heart rate, respiration rate, and arterial blood oxygen saturation (SpO(2)) were monitored, and adverse effects reported by patients or noted by clinicians were recorded at the same times. Study end points included total opioid consumption (infusion + boluses), demand:delivery ratio, and use of rescue medication.. One hundred twenty patients (63 men, 57 women; age range, 21-80 years; weight range, 40-120 kg) were included in the study. Seventy-four percent had other mild, treated diseases (American Society of Anesthesiologists physical class 2). Pain visual analog scale ratings were comparably high in all groups during the first 2 postoperative hours. Pain intensity ratings at 3 to 12 hours were significantly lower in those who received BUP-i + BUP-b compared with the other treatment groups (P = 0.018). The drug requirement during the postoperative period decreased significantly in all groups (P = 0.01); however, there was a significant difference between groups in the demand:delivery ratio at 3 to 12 hours (group * psydrug interaction, P = 0.026). The numerically lowest demand:delivery ratio was seen with BUP-i + BUP-b. BUP-i was associated with a significantly lower heart rate compared with the other groups (P = 0.027); there were no drug-related differences in respiration rate, SpO(2), or sedation. Patients' level of satisfaction with treatment was significantly higher in the group that received BUP-i + BUP-b compared with the other 3 groups (P < 0.001). Postoperative nausea and vomiting were mild and occurred at a similar incidence in all groups, as did rescue diclofenac use.. In these patients undergoing abdominal surgery, the BUP-i + BUP-b regimen controlled postoperative pain as well as did MO-i + MO-b or the combinations of BUP and MO. BUP neither inhibited the analgesia provided by MO nor induced undesired sedation or hemodynamic or respiratory effects.

Topics: Adult; Aged; Aged, 80 and over; Analgesia, Patient-Controlled; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Diclofenac; Digestive System Surgical Procedures; Double-Blind Method; Drug Therapy, Combination; Female; Gastrectomy; Hemodynamics; Humans; Infusions, Intravenous; Male; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Pancreatectomy; Patient Satisfaction; Prospective Studies; Respiration; Time Factors; Treatment Outcome; Wakefulness; Young Adult

To test the hypothesis that subarachnoid administration of buprenorphine and lidocaine provides more intense and longer lasting perioperative analgesia with less side effects than xylazine and lidocaine in goats.. Randomized, blinded, controlled study. STUDY ANIMALS: Ten healthy female goats randomly assigned to two groups of five animals each.. After sedation with acepromazine (0.1 mg kg(-1)) intravenously (i.v.), lidocaine 2% (0.1 mL kg(-1)) combined with either xylazine (0.05 mg kg(-1); Group X) or buprenorphine (0.005 mg kg(-1); Group B) were injected intrathecally at the lumbo-sacral junction prior to stifle surgery. Electrocardiogram, heart rate, direct systolic, mean, and diastolic arterial blood pressures, rectal temperature and arterial blood gases were recorded as were post-operative sedation and pain scores using a visual analogue and numeric rating scale, respectively. Data were analyzed with one-way ANOVA for repeated measures, one-way anova, Friedman's and Kruskal-Wallis tests as necessary (p < 0.05).. Surgery was successfully performed under both analgesia protocols. Total pain and sedation scores were significantly lower in the B as compared with X group from 3-24 hours and 30-120 minutes, respectively after subarachnoid drug administration (SDA). Heart rate and arterial blood pressures decreased post SDA and were consistently lower in X versus B (p < 0.05). In B arterial blood gas parameters did not change post SDA, but in group X PaCO(2) increased slightly within 15 minutes of SDA and remained elevated for at least 3 hours (p < 0.05).. In these goats intrathecal administration of buprenorphine and lidocaine produced more profound and longer lasting analgesia with less sedation and hemodynamic and respiratory impairment than xylazine with lidocaine.. In these goats undergoing hind limb surgery, subarachnoid buprenorphine/lidocaine offered more intense and longer lasting analgesia than a xylazine/lidocaine combination, with less sedation and impairment of cardiopulmonary function.

Topics: Adrenergic alpha-Agonists; Analgesics, Opioid; Anesthetics, Local; Animals; Buprenorphine; Drug Therapy, Combination; Female; Goats; Lidocaine; Pain, Postoperative; Stifle; Xylazine

This study was carried out to evaluate the postoperative analgesic effects of preoperative intravenous flurbiprofen in patients undergoing arthroscopic rotator cuff repair under general anesthesia.. We studied 44 patients who underwent an elective arthroscopic rotator cuff repair in a prospective, randomized, and double-blind fashion. The patients were divided into two groups. Group A (n = 22) received lipid emulsion 0.1 ml kg(-1) as a placebo, and group B (n = 22) received flurbiprofen 1 mg kg(-1) before the surgery. Intralipid or flurbiprofen was given intravenously 5 min before the surgery. General anesthesia was maintained with sevoflurane and nitrous oxide, and 10 ml of 0.75% ropivacaine was administered intraarticularly at the end of the surgery. Postoperative analgesia was supplied with intravenous 0.1 mg buprenorphine according to the patient's demand. The effectiveness of flurbiprofen's analgesic effect was measured by a visual analog scale (VAS) and by the amount of buprenorphine consumption at 0.5, 1, 2, 4, 6, 12, and 24 h after the surgery. Time to the first analgesic was also recorded.. VAS in group B was significantly (P < 0.01) lower than that in group A during the first 6 h postoperatively. The amount of buprenorphine consumption in group B was also significantly (P < 0.01) less than that in group A within the first 2 h postoperatively. The time to first analgesic request in group B was significantly (P < 0.01) longer than that in group A.. These results show that preoperative intravenous flurbiprofen facilitates the analgesic effect in the early postoperative period after arthroscopic rotator cuff repair.

Topics: Adult; Aged; Analgesics, Opioid; Anesthesia, General; Anti-Inflammatory Agents, Non-Steroidal; Arthroscopy; Buprenorphine; Female; Flurbiprofen; Humans; Injections, Intravenous; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Preoperative Care; Rotator Cuff; Young Adult

The demonstration that opioid receptors exist in the peripheral nervous system offers the possibility of providing postoperative analgesia in the ambulatory surgical patient. Over the previous decade, many investigators have studied this approach and have compared the efficacy of various opioids added to the local anesthetic near the brachial plexus; and it appears from several of these studies that buprenorphine provides the longest duration of analgesia, the most important parameter of postoperative analgesia in outpatients. One of these studies indicated that the agonist-antagonist, buprenorphine, added to bupivacaine provided a longer period of postoperative analgesia than the traditional opiates, but none of the studies was performed in patients undergoing minor oral surgery to check the efficacy of buprenorphine to provide postoperative analgesia in dental patients. The present study was undertaken to ascertain the efficacy of buprenorphine in providing prolonged postoperative analgesia when added to 0.5% bupivacaine with epinephrine 1:200,000.. Fifty healthy, consenting adult patients scheduled for upper extremity surgery were enrolled in the study. Patients were assigned randomly to 1 of 2 equal groups based on the agents used for the blocks. Patients in group I received 40 mL of a local anesthetic alone, and those in group II received the same local anesthetic plus buprenorphine 0.3 mg. The study was kept double-blind by having one dentist prepare the solutions, a second dentist perform the blocks, and a third dentist monitor the anesthesia and analgesia thereafter, up to and including the time of the first request for an analgesic medication. The data were reported as means +/- standard errors of the mean, and differences between groups were determined using t test. A P value less than .01 was considered statistically significant.. The mean duration of postoperative pain relief after injection of the local anesthetic alone was 8.34 +/- 0.11 hours compared with 28.18 +/- 1.02 hours after buprenorphine was added, a difference that was statistically (and clinically) significant (P < .001).. The addition of buprenorphine to the local anesthetic used for intraoral nerve blocks in the present study provided a 3-fold increase in the duration of postoperative analgesia, with complete analgesia persisting 30 hours beyond the duration provided by the local anesthetic alone in 75% of patients. This practice can be of particular benefit to patients undergoing minor oral surgery by providing prolonged analgesia after discharge from the hospital.

Topics: Adult; Ambulatory Surgical Procedures; Analgesics, Opioid; Anesthetics, Combined; Anesthetics, Local; Bupivacaine; Buprenorphine; Double-Blind Method; Female; Humans; Male; Mandible; Maxilla; Minor Surgical Procedures; Narcotic Antagonists; Nerve Block; Pain Measurement; Pain, Postoperative; Surgery, Oral

To compare the analgesic effects of buprenorphine, carprofen, and their combination in dogs undergoing ovariohysterectomy.. Prospective, randomized blinded clinical study.. 60 dogs.. Treatments were buprenorphine 0.02 mg kg(-1), intramuscularly (IM) (group B); carprofen 4 mg kg(-1), subcutaneously (SC) (group C); or a combination of both (group CB). Anesthesia was induced with propofol and maintained with isoflurane. A Dynamic Interactive Visual Analog Scale (DIVAS, 0-100 mm) and the Glasgow Composite Pain Scale (GCMPS, 0-24) were used to evaluate comfort and sedation at baseline, 2, 4, 6, and 24 hours after extubation. Rescue analgesia was provided with buprenorphine (0.02 mg kg(-1)). Wound swelling measurements (WM) and a visual inflammation score (VIS) of the incision were made after surgery and 2, 4, 6, and 24 hours later. p < 0.05 was considered significant.. Group C required more propofol (5.0 +/- 1.4 mg kg(-1)) compared with B (3.3 +/- 1.1 mg kg(-1)) and CB (3.2 +/- 0.7 mg kg(-1)); respectively, p = 0.0002 and 0.0001. Rescue analgesia was required in nine dogs. B had a higher GCMPS and DIVAS III score at 6 hours (2.6 +/- 2.5) and (23 +/- 22.5 mm) compared with C (1.0 +/- 1.3, 6 +/- 7.3 mm) and CB (1.5 +/- 1.4, 8 +/- 10.7 mm); respectively, p = 0.02 and 0.006. Group C had a lower sedation score at 2 hours (43 +/- 23.6 mm) compared with B (68 +/- 32.1 mm) and BC (69 +/- 22.1 mm); respectively, p = 0.03 and 0.004. Group B had a higher WM score at 2 hours (3 +/- 0.8 mm) compared with C (2 +/- 0.6 mm) p = 0.01 and at 6 hours (3 +/- 1 mm) compared with C (2 +/- 0.8 mm) and CB (2 +/- 0.8 mm); respectively, p = 0.01 and 0.008. VIS was not different between groups.. All treatments provided satisfactory analgesia for the first 6 hours and at 24 hours. C and CB pain score and WS were superior to B at 6 hours. No superior analgesic effect was noted when the drugs were combined.

Topics: Analgesics, Opioid; Anesthesia, General; Animals; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Carbazoles; Dogs; Drug Therapy, Combination; Female; Hysterectomy; Injections, Intramuscular; Injections, Subcutaneous; Pain Measurement; Pain, Postoperative; Preanesthetic Medication; Prospective Studies; Treatment Outcome

To evaluate the effect of buprenorphine administration on the cardiovascular and respiratory responses to noxious colorectal distension in conscious rabbits.. Prospective experimental trial.. Fifteen healthy, young adult New Zealand white rabbits (eight female).. Experiments were performed on conscious rabbits that were instrumented with intraabdominal arterial and venous catheters, and diaphragmatic and abdominal electromyographic electrodes. Colorectal distension was achieved by inflation of an acutely placed colorectal balloon catheter until mean arterial pressure increased 10-15 mmHg. Buprenorphine (0.06 mg) or saline was administered intravenously prior to, or during colorectal distension. Arterial blood pressure, heart rate, respiratory rate, abdominal electromyographic activity, and intra-balloon pressure were monitored.. In the absence of colorectal distension, buprenorphine increased arterial blood pressure and decreased respiratory rate but did not change heart rate. Colorectal distension increased arterial blood pressure and heart rate, and decreased respiratory rate. The increase in arterial blood pressure associated with colorectal distension was attenuated following preemptive buprenorphine, but was not changed by buprenorphine administered during distension.. If cardiovascular changes reflect the intensity of noxious stimulation, then these results support the preemptive administration of buprenorphine for visceral analgesia.

Topics: Analgesics, Opioid; Animals; Blood Gas Analysis; Blood Pressure; Buprenorphine; Catheterization; Colon; Consciousness; Female; Heart Rate; Injections, Intravenous; Male; Pain, Postoperative; Rabbits; Rectum; Respiration; Visceral Afferents

We wished to compare the effectiveness of intravenous-based (IV) and epidural-based (EPI) techniques for anesthesia and postoperative analgesia in elderly patients undergoing laparoscopic cholecystectomy. Effectiveness was compared in terms of reduction of postoperative pain and adverse events, and achieving a high level of patient satisfaction.. Thirty American Society of Anesthesiologists (ASA) physical status I-II patients aged more than 65 years, scheduled for laparoscopic cholecystectomy, were enrolled in this study. The patients in the IV group (n = 15) received modified neurolept anesthesia with droperidol 0.2 mgxkg(-1) and pentazocine 0.15-0.3 mgxkg(-1) (maximum dose of 1.0 mgxkg(-1)) and 60% nitrous oxide in oxygen, followed by postoperative intravenous infusion of 20 microgxml(-1) buprenorphine, provided with a patient-controlled analgesia pump programmed to deliver a bolus of 0.5 ml with a lockout interval of 15 min and a background infusion of 0.5 mlxh(-1). The patients in the EPI group (n = 15) had combined epidural analgesia and general anesthesia with sevoflurane and 60% nitrous oxide in oxygen, followed by the epidural infusion of a 0.125% bupivacaine and 5 microg x ml(-1) buprenorphine mixture by means of an on-demand analgesic system (bolus of 2 ml, lockout interval of 60 min, and background infusion of 2 mlxh(-1)).. The quality of postoperative analgesia was similar in the two groups. The incidences of intraoperative hypotension and bradycardia and postoperative hypotension were significantly lower in the IV group than in the EPI group (P < 0.05). A significantly higher level of patient satisfaction was found in the IV group compared with that in the EPI group (P < 0.05). The major contributor to dissatisfaction in the EPI group was anxiety or discomfort associated with the epidural procedures.. Modified neurolept anesthesia with pentazocine and postoperative i.v. analgesia with buprenorphine were superior to epidural-based techniques, in terms of hemodynamic stability and patient satisfaction, in elderly patients undergoing laparoscopic cholecystectomy.

Topics: Adjuvants, Anesthesia; Aged; Analgesia; Analgesia, Patient-Controlled; Analgesics, Opioid; Anesthesia, Epidural; Anesthesia, Intravenous; Anesthetics, Inhalation; Anesthetics, Local; Blood Pressure; Bupivacaine; Buprenorphine; Cholecystectomy, Laparoscopic; Droperidol; Female; Heart Rate; Humans; Male; Methyl Ethers; Nitrous Oxide; Pain Measurement; Pain, Postoperative; Patient Satisfaction; Pentazocine; Sevoflurane; Treatment Outcome

To evaluate the effect of preadministration of flurbiprofen on the plasma concentrations of prostaglandin E2 (PGE2) and postoperative pain.. Prospective, randomized, controlled and double-blind study.. Inpatient surgery at Nagasaki Rosai Hospital.. 32 ASA physical status I to II patients scheduled for total knee arthroplasty or open anterior cruciate ligament reconstruction.. Patients were randomly assigned to two groups. Five minutes before tourniquet inflation (350 mmHg), group A (n = 16) received placebo (intralipid, one mL . kg(-1)), and group B (n = 16) received flurbiprofen one mg . kg(-1) IV. Catheters were placed in the ipsilateral femoral vein for collection of local blood and in a cubital vein for sampling of systemic blood.. Prostaglandin E2 (femoral vein and cubital vein) was measured before tourniquet inflation (T1), before tourniquet deflation (T2), and immediately after tourniquet deflation (T3). Postoperative analgesia was provided with intravenous buprenorphine, 0.1 mg, on patient demand. Pain (Visual Analog Scale) was assessed at 0.5, one, two, 4, 6, 12 and 24 hours after surgery.. Visual Analog Scale and buprenorphine consumptions in group B were significantly lower than those in group A during the first 4 postoperative hours. In group A, PGE2 in femoral vein increased significantly at T2 (359 +/- 105 pg mL(-1), P < 0.0001), compared with T1 (211 +/- 61 pg mL(-1)) and returned to control values at T3 (252 +/- 77 pg mL(-1)), whereas PGE2 in the cubital vein showed no change. In group B, PGE2 in either the femoral vein or cubital vein showed no change throughout the time course.. Preadministration of flurbiprofen suppresses the local production of PGE2 during tourniquet ischemia, resulting in reduced early postoperative pain in patients undergoing knee surgery.

Topics: Analgesics; Analgesics, Opioid; Anterior Cruciate Ligament; Arthroplasty, Replacement, Knee; Buprenorphine; Dinoprostone; Double-Blind Method; Female; Flurbiprofen; Humans; Male; Middle Aged; Orthopedic Procedures; Pain Measurement; Pain, Postoperative; Preanesthetic Medication; Preoperative Care; Prospective Studies; Time Factors; Tourniquets

This study compared the efficacy of buprenorphine, carprofen, and a combination of the 2 analgesics in female baboons. Physiologic and behavioral parameters were assessed at baseline and postoperatively for 6 d by use of continuous noninvasive physiologic monitoring and twice-daily videotaping. Prior to surgery, all animals received a pre-emptive dose of either 0.01 mg/kg buprenorphine intramuscularly, 2.2 mg/kg carprofen intramuscularly, or a combination of 0.01 mg/kg buprenorphine and 2.2 mg/kg carprofen intramuscularly. All animals in the carprofen (n = 4) and buprenorphine+carprofen (n = 4) treatment groups appeared to have sufficient analgesia. Three of 4 animals in the buprenorphine group had adequate analgesia. The fourth animal had an elevated heart rate and spent less time standing during the postoperative period. In this study, the use of carprofen or a combination of carprofen plus buprenorphine provided more reliable postoperative analgesia than buprenorphine alone.

Topics: Analgesics; Animals; Body Weight; Buprenorphine; Carbazoles; Drug Therapy, Combination; Feeding Behavior; Female; Hydrocortisone; Pain Measurement; Pain, Postoperative; Papio anubis

We aimed to investigate the optimal dose of continuous epidural ropivacaine for effective analgesia with minimal side effects after axillary muscle-sparing thoracotomy.. Sixty patients undergoing thoracic surgery via the axillary approach were studied. Patients were given continuous epidural ropivacaine at 6 (group R-6), 9 (group R-9), 12 (group R-12) or 18 mg x h(-1) (group R-18) in a randomized double-blinded fashion after surgery. All of the patients received nonsteroidal anti-inflammatory drugs (NSAIDs) every 6 h for 24 h postoperatively. Pain intensity was assessed under three conditions (at rest, on moving, and while coughing), at 4, 8, 16, 24, and 48 h after surgery, and the extent of sensory block was evaluated at the same time points. The ability of a patient to walk unaided was assessed at 24 and 48 h after surgery.. Pain intensity at rest and coughing was significantly higher in group R-6 than in the other groups at 16 h after surgery. Pain intensity during moving was significantly greater in group R-6 than in groups R-12 and R-18 at 16 h after surgery. Group R-18 exhibited a significantly greater extent of sensory block than the other groups. The number of patients who were not able to walk unaided 24 h after surgery was significantly greater in group R-18. There were no significant differences in the incidences of side effects among the groups.. Our results showed that epidural analgesia using ropivacaine, at 12 mg x h(-1), provided the best analgesia with few side effects.

Topics: Aged; Amides; Analgesia, Epidural; Analgesics, Opioid; Analysis of Variance; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Prospective Studies; Ropivacaine; Thoracotomy; Time Factors

The present study compares the analgesic effect of a tepoxalin-buprenorphine combination to that of buprenorphine alone in the 24 h peri-operative period in 20 dogs undergoing cranial cruciate ligament repair, which were randomly assigned to the two treatment protocols (n = 10). Additionally, possible side effects induced by tepoxalin were investigated. Analgesia was compared using a visual analogue scale (VAS) and a multifactorial pain scale (MFPS), by an anaesthetist blinded from treatment. Analysis of the overall VAS-scores showed a significant decrease over time in both treatment groups. The decrease in the two groups was not significantly different from each other. No significant differences were found between the MFPS-scores of both protocols. Potential side effects of tepoxalin were investigated by venous blood sampling before premedication and 24 h after extubation, a buccal mucosal bleeding time test and recording of vomiting, diarrhoea and adverse effects at the surgical site. Analysis of the blood parameters showed that fibrinogen levels were overall higher 24 h after surgery in both protocols, but were significantly more elevated in the tepoxalin group. No significant differences were found for the other blood parameters. Statistically, tepoxalin failed to improve analgesia induced by buprenorphine. There was no convincing evidence that the administration of tepoxalin was not associated with gastrointestinal side effects. There were no significant adverse effects on renal function and primary haemostasis.

Topics: Analgesics, Opioid; Animals; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Buprenorphine; Dogs; Drug Therapy, Combination; Female; Male; Pain Measurement; Pain, Postoperative; Postoperative Care; Pyrazoles; Treatment Outcome

The purpose of this double-blind study was to evaluate the effect of intra-articular opioid injections on postoperative pain and joint mobility after arthrocentesis of the temporomandibular joint (TMJ).. Forty patients suffering from persistent pain in combination with anterior disc displacement (22 with reduction, 18 without reduction) and unresponsive to nonsurgical therapy underwent arthrocentesis of the affected TMJ under local anesthesia. All patients were randomly assigned to 2 groups. In group 1 (20 patients), 1 mL of buprenorphine solution was injected into the joint space at the end of the intervention; in group 2 (20 patients), 1 mL of saline was used. For postoperative pain management, all patients received Paracetamol ad libitum. Preoperatively and at postoperative days 2, 4, 7, and 14, individual pain levels were determined on a visual analogue scale together with maximum mouth opening.. At days 2 and 4 after the intervention, remarkable differences were detectable between the 2 groups, showing a rapid normalization of joint mobility and pain scores in group 1; in contrast, improvement in group 2 was delayed.. Intra-articular injections of long lasting opioids seem to influence joint mobility and pain positively within the first week after arthrocentesis.

Topics: Adult; Analgesics, Opioid; Buprenorphine; Epidemiologic Methods; Female; Humans; Male; Pain, Postoperative; Temporomandibular Joint

To evaluate signs of postoperative pain and complications after forelimb onychectomy in cats receiving buprenorphine alone or with bupivacaine administered as a 4-point regional nerve block.. Prospective, randomized, double-blind clinical trial.. 20 cats.. All cats received buprenorphine (0.01 mg/kg [0.004 mg/lb], IM) preoperatively. One forelimb of each cat also received bupivacaine (1 mg/kg [0.45 mg/lb] of a 0.75% solution) administered as a 4-point regional nerve block. After onychectomy, discomfort (lameness, foot reaction, and pain) scores were evaluated by 2 experienced observers 2, 4, 6, 8, 24, and 168 hours postoperatively. Complication (hemorrhage, swelling, and infection) scores were evaluated 24 and 168 hours postoperatively. Surgeries were performed by 1 experienced veterinary surgeon. Rescue analgesia was provided if needed.. 6 cats required rescue analgesia postoperatively. There was no difference in discomfort or complication scores between control limbs and limbs in which a nerve block was administered. Additionally, there was no difference in discomfort and complication scores between cats that did or did not require rescue analgesia.. Bupivacaine administered as a 4-point regional nerve block in addition to a systemic analgesic did not decrease discomfort or complication scores in cats undergoing forelimb onychectomy.

Topics: Analgesia; Analgesics, Opioid; Anesthetics, Local; Animals; Bupivacaine; Buprenorphine; Cats; Drug Therapy, Combination; Female; Forelimb; Hoof and Claw; Injections, Intramuscular; Male; Pain, Postoperative; Postoperative Care; Postoperative Complications; Prospective Studies; Time Factors; Treatment Outcome

Twenty-eight dogs were randomly allocated into two groups. They were premedicated with either 10 or 20 microg/kg buprenorphine and 0.05 mg/kg acepromazine administered intramuscularly, and then anaesthetised with intravenous thiopentone to effect and maintained with isoflurane in 100 per cent oxygen. The dogs underwent routine castration, and a second dose of 10 microg/kg buprenorphine was administered four hours after the first or 20 microg/kg six hours after the first dose. Levels of pain and sedation were scored on a visual analogue scale and in terms of the dogs' requirement for rescue analgesia, and mechanical nociceptive thresholds were measured at the hock and wound at premedication and one, two, three, four, five, six, seven, 10 and 21 to 22 hours later. Pain scores were low in both groups, with a trend for lower scores in the high dose group; administration of the second dose of buprenorphine further decreased the pain scores. Buprenorphine produced good preoperative sedation and the level of sedation decreased over time after surgery. Administration of the second high dose of buprenorphine did not increase the level of sedation. Both doses of buprenorphine prevented hyperalgesia at the wound and hock postoperatively. Three dogs given the low dose and one dog given the high dose required rescue analgesia with carprofen.

Topics: Analgesics, Opioid; Animals; Buprenorphine; Carbazoles; Conscious Sedation; Dogs; Dose-Response Relationship, Drug; Injections, Intramuscular; Male; Orchiectomy; Pain Measurement; Pain, Postoperative; Postoperative Care; Time Factors; Treatment Outcome

A placebo-controlled, randomized blind study was conducted in cats (n = 60) after fracture repair to compare the analgesic effects as well as the side-effects of carprofen, buprenorphine and levomethadone during a 5-day treatment. Cats with severe shock symptoms or increases in blood urea nitrogen (BUN) and creatinine were excluded from the study. The cats were randomly assigned to four groups (n= 15). In group 1, carprofen was administered upon extubation at an initial dose of 4 mg/kg body weight, followed by one-third of that dose three times daily on days 2 to 5. In group 2, buprenorphine was administered in a single dose of 0.01 mg/kg body weight upon extubation and subsequently every 8 h. Levomethadone (group 3) was applied according to the same scheme at a dosage of 0.3 mg/kg body weight each time. The placebo (group 4) was given at the same time intervals as the opioids. Examinations were carried out prior to anaesthesia, between 30 min and 8 h after extubation, and on the following 4 days, 1 h after administration of the analgesics or the placebo as well as 1 h before the next administration. Pain and sedation evaluation was carried out with a visual analogue system (VAS) and with the aid of a numerical estimation scale (NRS). Pain was also scored by measuring mechanical nociceptive threshold of traumatized tissue. Plasma glucose and cortisol concentration, heart rate, respiration rate, blood pressure and body temperature were measured. Furthermore, a complete blood count and clinical chemistry including BUN, creatinine, alanine aminotransferase (ALT), glutamate dehydrogenase (GLDH), arterial blood pressure (AP), total protein and electrolytes of the cats were checked on the day of admission as well as on the last day of this study (day 5). Defaecation and urination as well as wound healing were monitored. On the basis of the mechanical nociceptive threshold of the traumatized tissue, concentrations of plasma glucose and cortisol and pain assessment using NRS and VAS, carprofen was found to have better anti-nociceptive efficacy when compared with the two opioid analgesics, while the analgesic effect of levomethadone was similar to that of buprenorphine. However, the carprofen group also showed comparably high median NRS and VAS pain scores in addition to occasional broad deviations from the group mean on the first post-operative treatment day. Sedative effects were detected for buprenorphine and levomethadone; in addition, symptoms of central exci

Topics: Analgesics; Analgesics, Opioid; Animals; Buprenorphine; Carbazoles; Cats; Fractures, Bone; Methadyl Acetate; Orthopedics; Pain Measurement; Pain, Postoperative; Postoperative Care; Random Allocation; Treatment Outcome

To compare the analgesic efficacy of additional 0.1% bupivacaine to patient-controlled epidural analgesia (PCEA) using buprenorphine and droperidol after gynecological surgery.. Randomized, double-blinded study.. Operating theater and general ward at Jichi Medical School Hospital.. Thirty patients with American Society of Anesthesiologists physical status I and II scheduled for gynecological surgery.. Patients received combined general and epidural anesthesia for surgery and epidural analgesia for postoperative analgesia. Patients were assigned to receive PCEA with or without 0.1% bupivacaine. Group 1 (n = 15) received buprenorphine 20 microg and droperidol 0.1 mg diluted with saline, and group 2 (n = 15) received bupivacaine 2 mg, buprenorphine 20 microg, and droperidol 0.1 mg diluted with saline (0.1% bupivacaine solution) in a bolus dose of the PCEA, respectively. No background epidural infusion was used.. Visual analog pain scale (VAPS) scores at rest and on coughing, and cumulative frequency of self-administrated analgesic solution in PCEA were recorded at 24 and 48 hours postoperatively.. There were no significant differences noted between the groups in VAPS scores at rest or in cumulative volumes of PCEA solution in 24 or 48 hours postoperatively. Median VAPS scores on coughing in group 2 were significantly lower than those values in group 1 at 24 hours (36 vs 65 mm, P < .001) and 48 hours (32 vs 54 mm, P = .036) postoperatively.. Addition of 0.1% bupivacaine to PCEA using buprenorphine and droperidol provides better analgesia on coughing after gynecological surgery.

Topics: Adult; Analgesia, Epidural; Analgesia, Patient-Controlled; Bupivacaine; Buprenorphine; Central Nervous System Agents; Cough; Double-Blind Method; Droperidol; Female; Gynecologic Surgical Procedures; Humans; Middle Aged; Pain Measurement; Pain, Postoperative; Treatment Outcome

The continuous subcutaneous infusion (CSI) technique is a simple, inexpensive method for managing postoperative pain. We examined the analgesic effects of CSI of buprenorphine in patients undergoing lumbar spinal fusion surgery.. The patients were randomly assigned to one of three groups for postoperative pain management: control group (n = 17), high-dose buprenorphine group (BH group, n = 17), and low-dose buprenorphine group (BL group, n = 16). Infusion solutions containing buprenorphine at concentrations of 25.0 and 16.7 microg x ml(-1) combined with droperidol at a concentration of 52.0 microg x ml(-1) were used in the BH and BL groups, respectively; and an infusion solution containing droperidol at a concentration 52.0 microg x ml(-1) was used in the control group. CSI of each solution was started at a rate of 1 ml x h(-1) and was continued for 48 h.. The BH and BL groups showed significantly lower scores than the control group on the Visual Analogue Scale. There were significantly fewer administrations of flurbiprofen as a supplemental analgesic in the BL and BH groups than in the control group. The incidences of sedation and nausea were comparable in the three groups. The median number of administrations of flurbiprofen was significantly less in the BH group than in the control group on the day of the operation and on the first postoperative day, whereas the number in the BL group was less than that in the C group only on the day of the operation.. CSI of buprenorphine effectively reduces pain after lumbar spinal fusion surgery without apparent side effects. This technique is simple and useful for postoperative pain management.

Topics: Adult; Aged; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Double-Blind Method; Female; Fentanyl; Flurbiprofen; Humans; Injections, Subcutaneous; Lumbar Vertebrae; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Spinal Fusion

The present study was designed to evaluate the efficacy of a cyclooxygenase (COX)-2 inhibitor, etodolac, on postoperative pain after fast-track cardiac surgery, and to examine the changes in plasma etodolac concentration after oral administration.. Thirty patients scheduled for elective coronary artery bypass grafting (CABG) surgery were randomly assigned preoperatively in a double-blind fashion to receive either vehicle ( n = 15) or etodolac 400 mg ( n = 15) via a gastric tube at the end of the surgery. Standardized fast-track cardiac anesthesia was used. In both groups, postoperative pain was treated with buprenorphine suppository. Visual analogue pain scores (VASs) were recorded immediately after extubation and at 24 h after surgery. Plasma etodolac concentration was measured at 1, 2, and 6 h after administration ( n = 8).. No difference was detected in time to extubation between the etodolac group (209 +/- 85 min, mean +/- SD) and the vehicle group (207 +/- 98 min). VASs were significantly lower in the etodolac (2.3 +/- 2.1) vs the vehicle group (5.8 +/- 2.0) immediately after extubation ( P = 0.009), but no difference was detected in pain scores at 24 h after surgery, or in the amount of buprenorphine administered in the intensive care unit (ICU), or in the incidence of side effects. Plasma etodolac concentration was within the pharmaceutically recommended range at 1 h, 2 h, and 6 h after administration.. The oral use of etodolac with rectal buprenorphine reduces pain scores immediately after cardiac surgery without an increase in side effects.

Topics: Administration, Oral; Aged; Analgesics, Opioid; Buprenorphine; Coronary Artery Bypass; Cyclooxygenase Inhibitors; Double-Blind Method; Etodolac; Female; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Suppositories

Acute withdrawal syndromes, including agitation and a long weaning time, are common adverse effects after long-term sedation with midazolam. We performed this study to determine whether the sequential use of midazolam and propofol could reduce adverse effects as compared with midazolam alone. We studied 26 patients receiving mechanical ventilation for three or more days after surgery. Patients were randomly assigned to two groups. In Group M, patients were sedated with midazolam alone. In Group M-P, midazolam was switched to propofol approximately 24 h before the expected stopping of sedation. The level of sedation was maintained at 4 or 5 on the Ramsay sedation scale. The sedation agitation scale was evaluated for 24 h after extubation. The recovery time from stopping of sedation to extubation was significantly shorter in Group M-P (1.3 +/- 0.4 h) compared with Group M (4.0 +/- 2.4 h). The incidence of agitation in Group M-P (8%) was significantly less frequent than that in Group M (54%). The results indicate that sequential use of midazolam and propofol for long-term sedation could reduce the incidence of agitation compared with midazolam alone.. Our study indicates that sequential use of midazolam and propofol could reduce the incidence of agitation compared with midazolam alone.

Topics: Analgesics, Opioid; Buprenorphine; Conscious Sedation; Female; Humans; Hypnotics and Sedatives; Male; Midazolam; Middle Aged; Pain, Postoperative; Postoperative Period; Propofol; Psychomotor Agitation; Respiration, Artificial

Intrathecal injections of the benzodiazepine midazolam have been reported to cause antinociception in animals and pain relief in human beings, including the potentiation of opioid analgesia. This study compared the efficacy of the addition of midazolam to a mixture of buprenorphine and bupivacaine used for spinal anaesthesia.. The study was prospective, randomized, and observer blinded. It involved 60 patients (30 per group), ASA I and II, age 20-40 yr, undergoing minor and intermediate lower abdominal surgery under spinal anaesthesia. Patients were randomized into two groups: the control group received a spinal injection of hyperbaric bupivacaine (15 mg) plus buprenorphine (0.15 mg) and the experimental group received a spinal injection of the same two drugs and doses but supplemented with intrathecal midazolam (2 mg).. The duration of postoperative analgesia in the control group was 9.24 +/- 2.57 h (mean +/- SEM), and 21.33 +/- 12.69 h in the midazolam treated group (P < 0.001). Patients treated with intrathecal midazolam had better pain relief judged by visual analogue score on coughing (P = 0.0013) and a nursing mobility score (P < 0.0001). Adverse effects were minor and their incidence was similar in both groups.. We conclude that intrathecal midazolam 2 mg improves the quality and duration of postoperative pain relief afforded by intrathecal buprenorphine and bupivacaine.

Topics: Abdomen; Adult; Analgesics, Opioid; Anesthesia, Spinal; Anesthetics, Combined; Anesthetics, Intravenous; Anesthetics, Local; Bupivacaine; Buprenorphine; Chi-Square Distribution; Drug Synergism; Humans; Injections, Spinal; Midazolam; Pain Measurement; Pain, Postoperative; Prospective Studies; Time Factors

To evaluate the perioperative antinociceptive effect of intrathecal morphine (a pure mu agonist), intravenous (IV) buprenorphine (a partial mu agonist) or their combination.. Randomized, double-blind, placebo-controlled study.. Anesthesiology department of a university-affiliated public hospital.. 45 ASA physical status I, II, and III patients undergoing hysterectomy with general anesthesia.. Preoperative and postoperative regimens consisted of intrathecal morphine 4.3 microg.kg(-1) plus IV 0.9% saline (Group 1), IV buprenorphine 1.3 microg.kg(-1) plus intrathecal saline (Group 2), and intrathecal morphine 4.3 microg.kg(-1) plus IV buprenorphine 1.3 microg.kg(-1) (Group 3; postoperative supplements consisting of IV buprenorphine 1.3 microg.kg(-1) plus intrathecal saline).. Group 2 and 3 patients were given three analgesic dosings compared with two dosings in Group 1 (p < 0.001). The duration of action in Group 2 was significantly shorter (p = 0.001) than in the other two groups. The 12-hour postoperative pain intensity and sedation in Group 3 was significantly lower (p < 0.05) than in the other groups. Side effects (mainly pruritus and nausea and vomiting) were significantly fewer (p < 0.05) in Groups 2 and 3 (26% and 28%, respectively) than in Group 1 (46%).. The concomitant administration of intrathecal morphine and IV buprenorphine alleviates pain sensation and minimizes sedation more effectively than when given after the administration of either drug separately. In addition, IV buprenorphine affords a reduction in side effects.

Topics: Analgesics, Opioid; Anesthesia, General; Buprenorphine; Double-Blind Method; Female; Humans; Hysterectomy; Injections, Intravenous; Injections, Spinal; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative

We compared the effects of extradural with intravenous (i.v.) buprenorphine on postoperative pain and recovery characteristics.. Thirty patients, aged 11-13 years, who were undergoing inguinal hernia repair with or without orchidopexy, were randomly allocated to receive either caudal 0.5% bupivacaine alone (group A) or were additionally given i.v. buprenorphine 2.5 micro g.kg-1 (group B) or caudal buprenorphine in the same dose (group C). Patients were followed for 8 h after the end of surgery.. All patients remained haemodynamically stable during the study period and no clinical respiratory depression was seen. Nausea, vomiting, urinary retention and pruritus were more common in the extradural buprenorphine group. Three patients in group A, five in group B and eight in group C did not require any additional analgesia during the study period. The incidence of vomiting was 20%, 50% and 80% in groups A, B and C, respectively. Four patients in group C had urinary retention compared with one each in the other two groups.. Administration of buprenorphine resulted in a higher incidence of side-effects.

Topics: Adolescent; Analgesics, Opioid; Anesthesia Recovery Period; Anesthetics, Local; Bupivacaine; Buprenorphine; Child; Cryptorchidism; Hernia, Inguinal; Humans; Injections, Epidural; Injections, Intravenous; Male; Pain, Postoperative; Postoperative Nausea and Vomiting

Individual differences in pharmacokinetics and pharmacodynamics, the type of pain and the method of drug administration can account for the response variability to analgesics. By integrating a clinical and an experimental approach, we report here that another important source of variability is represented by individual differences in non-specific (placebo) activation of endogenous opioid systems. In the first part of this study, we analyzed the effectiveness of buprenorphine, tramadol, ketorolac and metamizol in the clinical setting, where the placebo effect was completely eliminated by means of hidden infusions. We found that the hidden injections were significantly less effective and less variable compared with open injections (in full view of the subject), suggesting that part of the response variability was due to non-specific factors (placebo). Since we could not administer the opioid antagonist, naloxone, to these patients, in the second part of this study, we induced experimental ischemic arm pain in healthy volunteers and found that, as occurred in clinical pain, the analgesic response to a hidden injection of the non-opioid ketorolac was less effective and less variable than an open injection. Most importantly, we obtained the same effects by adding naloxone to an open injection of ketorolac, thus blocking the opioid-mediated placebo component of analgesia. These findings indicate that both the psychological (hidden injection) and pharmacological (naloxone) blockade of the placebo response reduce the effectiveness of, and the response variability to, analgesic drugs. Therefore, an important source of response variability to analgesics appears to be due to differences in non-specific activation of endogenous opioid systems.

Topics: Adult; Aged; Buprenorphine; Dipyrone; Female; Humans; Ketorolac; Male; Middle Aged; Opioid Peptides; Pain Measurement; Pain, Postoperative; Tramadol

The effect of intravenous buprenorphine on emergence time from sevoflurane anesthesia and postoperative analgesic requirement was evaluated after otolaryngeal surgeries. Forty-five patients were randomly assigned to one of three treatment groups (n = 15 each): Control-group received saline as a control; 2 micrograms-group received buprenorphine 2 micrograms.kg-1; and 4 micrograms-group received buprenorphine 4 micrograms.kg-1, respectively. Study drug was administered intravenously at the induction of general anesthesia. Anesthesia was maintained with sevoflurane (1.5%) and nitrous oxide (66%) in oxygen. The pain score, postoperative analgesic requirement, and incidence of nausea and/or vomiting were examined. The emergence times were 16.4 +/- 3.5, 14.7 +/- 5.2, and 17.8 +/- 7.7 min [mean +/- SD], in the control-group, the 2 micrograms-group, and the 4 micrograms-group, respectively. There were no differences among the groups in term of the end-tidal sevoflurane concentration immediately before tracheal extubation. In the control-group, the 2 micrograms-group, and the 4 micrograms-group, 10, 1, and 3 patients, requested additional analgesics during the first 24 hours after surgery, respectively (control-group vs. 2 micrograms-group and 4 micrograms-group, P < 0.05). Nausea and vomiting occurred more frequently in the 2 micrograms-group and the 4 micrograms-group. We conclude that buprenorphine (2 or 4 micrograms.kg-1) reduced analgesic requirement during the first 24 hours after surgery without delaying emergence from sevoflurane anesthesia.

Topics: Adult; Analgesics, Opioid; Anesthesia Recovery Period; Anesthesia, General; Buprenorphine; Dose-Response Relationship, Drug; Female; Humans; Male; Methyl Ethers; Middle Aged; Otorhinolaryngologic Surgical Procedures; Pain, Postoperative; Postoperative Nausea and Vomiting; Preanesthetic Medication; Sevoflurane; Treatment Outcome

Response expectancies have been proposed as the major determinant of placebo effects. Here we report that different expectations produce different analgesic effects which in turn can be harnessed in clinical practice. Thoracotomized patients were treated with buprenorphine on request for 3 consecutive days, together with a basal intravenous infusion of saline solution. However, the symbolic meaning of this basal infusion was changed in three different groups of patients. The first group was told nothing about any analgesic effect (natural history). The second group was told that the basal infusion was either a powerful painkiller or a placebo (classic double-blind administration). The third group was told that the basal infusion was a potent painkiller (deceptive administration). Therefore, whereas the analgesic treatment was exactly the same in the three groups, the verbal instructions about the basal infusion differed. The placebo effect of the saline basal infusion was measured by recording the doses of buprenorphine requested over the three-days treatment. We found that the double-blind group showed a reduction of buprenorphine requests compared to the natural history group. However, this reduction was even larger in the deceptive administration group. Overall, after 3 days of placebo infusion, the first group received 11.55 mg of buprenorphine, the second group 9.15 mg, and the third group 7.65 mg. Despite these dose differences, analgesia was the same in the three groups. These results indicate that different verbal instructions about certain and uncertain expectations of analgesia produce different placebo analgesic effects, which in turn trigger a dramatic change of behaviour leading to a significant reduction of opioid intake.

Topics: Aged; Analgesics; Analgesics, Opioid; Buprenorphine; Double-Blind Method; Female; Humans; Male; Middle Aged; Pain, Postoperative; Placebo Effect

We investigated the efficacy of postoperative intravenous patient controlled analgesia (i.v.-PCA) combined with continuous epidural analgesia (CEA) after thoracotomy. One hundred and eight patients receiving postoperative CEA were randomly divided into two groups; the i.v.-PCA (+) group who received i.v.-PCA combined with CEA and the i.v.-PCA (-) group who did not receive i.v.-PCA. Pain score (100 mm visual analogue scale; VAS) at 24 h and 48 h, postoperative complications, activities of daily life (ADL), the length of hospital stay and medical expense were compared. The length of hospital stay and medical expense were not significantly different between the two groups. The i.v.-PCA (+) group could recover ADL more quickly and had better analgesic state compared with the i.v.-PCA (-) group. The incidence of postoperative complications was lower in the i.v.-PCA (+) group compared with the i.v.-PCA (-) group. It was concluded that the i.v.-PCA combined with CEA had the desirable effects on postoperative analgesia and recovery of postoperative ADL.

Topics: Activities of Daily Living; Analgesia, Epidural; Analgesia, Patient-Controlled; Buprenorphine; Female; Fentanyl; Humans; Infusions, Intravenous; Length of Stay; Male; Middle Aged; Pain, Postoperative; Postoperative Care; Thoracotomy

Concurrent administration of opioids with different affinity produces synergistic antinociceptive effect in rats. We tested the perioperative antinociceptive effects of the simultaneous double blind administration of morphine, a pure agonist and buprenorphine, a partial agonist, in 30 patients undergoing hysterectomy under general anesthesia. Pre- and post-operatively regimens consisted of random patient assignment to intrathecal 0.3 mg morphine plus intravenous saline (group 1), intravenous 0.09 mg buprenorphine plus intrathecal saline (group 2) or intrathecal morphine 0.3 mg plus intravenous buprenorphine 0.09 mg (group 3). Postoperative pain relief for group 3 consisted of supplementation of intravenous buprenorphine plus intrathecal saline. The immediate postoperative pain, sedation and anxiety levels (by numerical or categorical scores) were similar among all groups. The 12-hour pain and sedation scores were significantly (P < 0.05) lower in group 3 than in the other two groups. Buprenorphine-induced analgesia in group 3 lasted significantly (P < 0.05) longer than in group 2. Side effects in groups 2 and 3 were by 44% and 42% fewer than in group 1, respectively, with no withdrawal symptoms. Thus, concomitant administration of intrathecal morphine and low dose intravenous buprenorphine produces better and longer pain relief than intravenous buprenorphine alone in women after hysterectomy.

Topics: Adult; Analgesia; Anesthesia, General; Buprenorphine; Double-Blind Method; Drug Synergism; Drug Therapy, Combination; Female; Humans; Hysterectomy; Injections, Intravenous; Middle Aged; Morphine; Pain, Postoperative

Eighty patients undergoing major abdominal surgery using remifentanil-based anaesthesia were randomly allocated in a double-blind manner to receive an intravenous bolus of fentanyl, buprenorphine, morphine or piritramide 20 min before the end of surgery. A reduced dose was administered postoperatively when patients reported moderate pain. Subsequent analgesia was provided by patient-controlled analgesia (PCA). The mean time from the end of anaesthesia to spontaneous respiration was 9 +/- 5 min. At first pain assessment, 63% of patients reported no or mild pain; 80% of patients required the second opioid bolus, those receiving piritramide needed the bolus significantly later than patients receiving buprenorphine or fentanyl. First PCA requirement also occurred significantly later in the piritramide group. This technique provided effective postoperative pain relief and transition to routine PCA and did not compromise recovery.

Topics: Abdomen; Adult; Aged; Aged, 80 and over; Analgesia, Patient-Controlled; Analgesics, Opioid; Anesthesia Recovery Period; Buprenorphine; Double-Blind Method; Female; Fentanyl; Humans; Intraoperative Care; Male; Middle Aged; Morphine; Pain, Postoperative; Pilot Projects; Piperidines; Pirinitramide; Remifentanil

The use of pigs as research animals in survival surgery has increased greatly in the last 15 years. Personnel conducting pig research have been hampered by a lack of proven long-acting analgesics for treatment of surgical pain of longer duration, and by a lack of reliable non-subjective parameters for the assessment of pain relief. The efficacy of the mixed opioid agonist-antagonist buprenorphine hydrochloride 0.10 mg/kg pr (n = 2) in the treatment of post-thoracotomy pain was compared with that of a transdermal therapeutic system (TTS) delivering 25 microg/h (n = 3) or 50 microg/h (n = 2) of the mu opioid agonist fentanyl hydrochloride. Food consumption, pain score, activity level and rate of movement were assessed under four conditions: normal pre-operative control (24h), pre-operative with analgesic alone (24h) and post-operative days 1, 2, 3 (72h). Serum concentration-time curves for fentanyl in clinical cases revealed that female Yorkshire cross pigs weighing 26.2+ 2.1 kg achieved serum values in the recognized human therapeutic range when treated with TTS fentanyl at 50 microg/h and experienced adequate pain control. Pigs treated with 25 microg/h TTS fentanyl had serum levels below the human analgesic range, experienced less adequate analgesia, and required supplemental analgesia in some cases. Based on existing pharmacokinetic data for fentanyl in pigs, the rate of uptake of TTS fentanyl when attached on inter-scapular skin was lower than predicted. Clinical pain scores and time intervals between each major postural change were not affected by analgesics in the absence of pain, but increased in all groups after surgery regardless of treatment. Food consumption was unaffected by analgesic treatment alone but decreased in all groups after surgery regardless of treatment. Analgesic effects on postoperative activity level were variable. TTS fentanyl at appropriate doses is a cost effective means of delivering basal analgesia following major surgery in pigs.

Topics: Administration, Cutaneous; Analgesics, Opioid; Animals; Buprenorphine; Drug Administration Schedule; Energy Intake; Female; Fentanyl; Humans; Infusions, Parenteral; Movement; Pain, Postoperative; Postoperative Period; Swine

We compared the efficacy of intravenous patient controlled analgesia of buprenorphine plus continuous thoracic epidural infusion of bupivacaine (IV-PCA group) with the efficacy of continuous thoracic epidural infusion of bupivacaine and buprenorphine (the TEA group). No patient in IV-PCA group required supplemental analgesics, while 90% of TEA group required supplemental intramuscular buprenorphine to relieve post-thoracotomy pain. In TEA group, 94% of the supplemental drugs were administered during night shifts. These results indicate that IV-PCA of buprenorphine combined with continuous thoracic epidural infusion of bupivacaine is more effective analgesic management than continuous TEA with buprenorphine and bupivacaine.

Topics: Adult; Analgesia, Epidural; Analgesia, Patient-Controlled; Analgesics, Opioid; Anesthetics, Local; Bupivacaine; Buprenorphine; Humans; Middle Aged; Pain, Postoperative; Thoracotomy

Demonstration of peripheral opioid receptors in inflamed synovia supports the concept of peripheral opioid analgesia. The aim of this study was to evaluate the analgesic effect of intra-articular administration of buprenorphine after knee arthroscopy.. In a double-blind randomised trial, 48 patients were assigned to four groups: group A patients received buprenorphine 100 micrograms i.a. and NaCl 0.9% i.m., group B patients received bupivacaine 0.25% 50 mg i.a. and NaCl 0.9% i.m., group C patients received NaCl 0.9% i.a. and buprenorphine 100 micrograms i.m., and group D patients received NaCl 0.9% i.a. and NaCl 0.9% i.m. Intensity of postoperative pain was evaluated by VAS at recovery (T0) and 1, 3, 6, 12, 24 h after operation (T1, T2, T3, T4, T5), at rest and during passive 10 degrees knee flexion. Total analgesic requirements and side effects related to study drugs were recorded.. The VAS scores were significantly higher in groups C and D than in group A and B patients. The differences were significant at T0, T1, T2 and T3. At T1, group C and D patients had greater analgesic requirement than groups A and B. No patients developed side effects.. Intra-articular buprenorphine and i.a. bupivacaine, both produced equally good postoperative pain control and allowed a significant reduction of analgesic requirement after knee arthroscopy.

Topics: Adult; Analgesics, Opioid; Analysis of Variance; Anesthetics, Local; Arthroscopy; Bupivacaine; Buprenorphine; Double-Blind Method; Endoscopy; Female; Follow-Up Studies; Humans; Injections, Intra-Articular; Injections, Intramuscular; Knee Joint; Male; Pain Measurement; Pain, Postoperative; Patient Satisfaction; Placebos; Prospective Studies

Thoracic epidural analgesia (TEA) is reported to provide effective analgesia following cardiac surgery. We compared the effect of buprenorphine (BN) through the lumbar and thoracic epidural routes for postoperative analgesia following coronary artery bypass graft surgery (CABG).. Forty patients with normal left ventricular ejection fraction scheduled for CABG were randomly divided into two groups, the TEA group (n = 19) and the lumbar epidural analgesia (LEA) group (n = 20). For postoperative pain relief they received epidural BN 0.15 mg at the first demand for pain relief following extubation. A top-up dose of BN 0.15 mg was administered in cases where visual analogue scale (VAS) score was > 3 at 1 h after first dose. Subsequent breakthrough pain was treated with 30 mg intramuscular ketorolac tromethamine (ketorolac). Pain assessed by VAS score on a 0-10 scale, respiratory rate, FEV1, FVC, mean arterial blood pressure, cardiac index, PaO2 and PaCO2 were measured at frequent intervals. Side effects of epidural opioids were noted.. Both groups were comparable in demographic characteristics, had similar VAS scores from 1 to 24 h postoperatively, required similar amounts of intramuscular ketorolac for break-through pain and had comparable pulmonary functions and side effects.. This study shows that BN by the lumbar epidural route for analgesia after CABG compares favourably with the same drug through the thoracic route in terms of quality of analgesia and incidence of side effects.

Topics: Adult; Aged; Analgesia, Epidural; Analgesics, Non-Narcotic; Analgesics, Opioid; Blood Pressure; Buprenorphine; Carbon Dioxide; Cardiac Output; Coronary Artery Bypass; Female; Forced Expiratory Volume; Humans; Injections, Intramuscular; Ketorolac Tromethamine; Lumbar Vertebrae; Male; Middle Aged; Oxygen; Pain Measurement; Pain, Postoperative; Respiration; Stroke Volume; Thoracic Vertebrae; Tolmetin; Tromethamine; Ventricular Function, Left; Vital Capacity

Buprenorphine (0.1, 0.2, 0.3 or 0.4 mg/kg) in a flavoured gelatin base was administered preoperatively to rats undergoing a flank laparotomy. A control group of animals underwent surgery and received only flavoured gelatin. Body weight loss was significantly greater in the group which received no analgesia than in any of the analgesic-treated groups (P < 0.01). Food consumption was reduced significantly in all groups except in those animals which received 0.3 mg/kg buprenorphine. Water consumption was significantly reduced in the control (no analgesia) group (P < 0.001), but was not significantly depressed in the analgesic-treated groups (P > 0.05). Between-group comparisons did not show any significant difference between the different dose rates of analgesia used on either the change in body weight or the reduction in food or water consumption. The results of this study support the use of buprenorphine jelly for post-surgical analgesia in rats. This route of delivery is easy to use, and causes a minimum of stress to the rats.

Topics: Administration, Oral; Analgesia; Analgesics, Opioid; Animals; Body Weight; Buprenorphine; Drinking; Eating; Female; Gelatin; Laparotomy; Pain, Postoperative; Preoperative Care; Rats; Rats, Wistar; Specific Pathogen-Free Organisms; Stomach

To determine whether the continuous low thoracic extradural administration of the same dose of lidocaine at low concentration with a high infusion rate or at high concentration with a low infusion rate in combination with a fixed dose of buprenorphine (0.4 mg.day-1) modifies postoperative pain relief.. Twenty-eight patients undergoing elective upper abdominal surgery were randomly allocated to one of two groups to receive lidocaine 2%--buprenorphine at a rate of 6.3 ml.hr-1 (2% group, n = 13) or lidocaine 6%-buprenorphine at a rate of 2.1 ml.hr-1 (6% group, n = 15). During suture of the peritoneum, mepivacaine 2% (8 ml) with 0.1 mg (0.5 ml) buprenorphine was infused extradurally. After extubation, the continuous extradural infusion was initiated. Patients were assessed for the level of analgesia with the 10 cm VAS score at rest and with the Prince Henry Pain Scale (PHPS) at 3, 6, 9, 12, 18, and 24 hr postoperatively.. The visual analogue scale (VAS) scores at rest did not differ between the two groups except at 18 hr after surgery. The Prince Henry Pain Scale (PHPS) scores were not different between the two groups postoperatively.. There was no difference in analgesia produced by the continuous extradural infusion of lidocaine 2%-buprenorphine at a rate of 6.3 ml.hr-1 and that of lidocaine 6%-buprenorphine at a rate of 2.1 ml.hr-1 following upper abdominal surgery.

Topics: Adult; Aged; Analgesia, Epidural; Analgesics, Opioid; Analysis of Variance; Anesthetics, Local; Buprenorphine; Cholecystectomy; Drug Combinations; Elective Surgical Procedures; Female; Follow-Up Studies; Gastrectomy; Humans; Infusion Pumps; Lidocaine; Male; Middle Aged; Nausea; Pain Measurement; Pain, Postoperative; Pentazocine; Prospective Studies; Single-Blind Method; Time Factors

Combined spinal-epidural anesthesia is a useful technique. However, there has been no attempt to investigate the risk of epidural opioid, especially buprenorphine, flux through the dural hole. The purpose of this study was to compare the effect of epidural buprenorphine administered across the dura into subarachnoid space, between two different methods of administration; bolus injection (Group I) and continuous infusion (Group II). Sixty patients for transvaginal hysterectomy were divided into two groups. Group I received buprenorphine 0.1-0.2 mg with 0.25% bupivacaine, and Group II 0.4 mg with 0.25% bupivacaine 40 ml continuously (infusion rate was 1.7 ml.h-1). Pain relief was similar in both groups, but the total buprenorphine requirement was lower in Group I than in Group II. The incidence of nausea and vomiting was significantly higher in Group I than that in Group II, 73% and 16%, respectively. It indicates that the increase of nausea and vomiting is predominantly determined by a high rate of flux into subarachnoid space and only partly determined by blood concentrations. In contrast to continuous infusion, the drug movement through the dural hole may increase by bolus injection due to its higher pressure. We recommend careful injection of epidural buprenorphine such as by continuous infusion with low pressure after combined spinal-epidural anesthesia.

Topics: Adult; Analgesics, Opioid; Anesthesia, Epidural; Anesthesia, Spinal; Buprenorphine; Female; Humans; Hysterectomy, Vaginal; Injections, Epidural; Middle Aged; Nausea; Pain, Postoperative; Vomiting

The treatment of neuropathic pain with opioid analgesics is a matter of controversy among clinicians and clinician scientists. Although neuropathic pain is usually believed to be only slightly responsive to opioids, several studies show that satisfactory analgesia can be obtained if adequate doses are administered. In the present study, we tested the effectiveness of buprenorphine in 21 patients soon after thoracic surgery (nociceptive postoperative pain) and 1 month after surgery in the same 21 patients who developed postthoracotomy neuropathic pain with a burning, electrical and shooting quality. According to a double-blind randomized study, the analgesic dose (AD) of buprenorphine needed to reduce the long-term neuropathic pain by 50% (AD50) was calculated and compared to the AD50 in the immediate postoperative period. We found that long-term neuropathic pain could be adequately reduced by buprenorphine. However, the AD50 in neuropathic pain was significantly higher relative to the AD50 in the short-term postoperative pain, indicating a lower responsiveness of neuropathic pain to opioids. We also found a strict relationship between the short-term and long-term AD50, characterized by a saturating effect. In fact, if the AD50 soon after surgery was low, the AD50 increase in the long-term neuropathic pain was threefold. By contrast, if the AD50 soon after surgery was high, the AD50 in neuropathic pain was only slightly increased. This suggests that, though neuropathic pain is indeed less sensitive to opioids, in some neuropathic patients a large amount of opioid resistance is already present in other painful conditions.

Topics: Aged; Analgesics, Opioid; Buprenorphine; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Male; Middle Aged; Nociceptors; Pain Threshold; Pain, Postoperative; Peripheral Nerve Injuries; Skin; Thoracotomy; Time Factors

We studied the analgesic effects of continuous epidural injection of buprenorphine in patients after lower extremity arthroplasty. In these patients anesthesia was maintained only with lumbar epidural anesthesia with 2% mepivacaine. We employed a balloon type continuous infuser (DIB Catheter, 40 ml.day-1) for postoperative analgesia for twenty-four hours. The patients were classified into three groups according to the method of buprenorphine injection and the content of DIB Catheter. First group (group A ; N = 37) received buprenorphine (0.2 mg) with 0.25% bupivacaine (40 ml) for twenty-four hours. Next group (group B ; N = 27) received bolus injection of buprenorphine (0.2 mg) for the first additional epidural injection of local anesthetic and received continuous injection of buprenorphine (0.2 mg) with 0.25% bupivacaine (40 ml) for twenty-four hours. The last group (Group C ; N = 40) also received bolus injection of buprenorphine as in group B, but received continuous buprenorphine infusion with normal saline instead of local anesthetics. The analgesic effect was determined by the postoperative usage of other analgesics (NSAID or pentazocine) by request of patients. In twenty-four hours, the numbers of patients who did not request other analgesics were 6 (Group A. 16%), 9 (Group B. 33%) and 19 (Group C. 48%), respectively. In Group A, 18 patients requested analgesics, but only 8 patients requested in Group C. It was effective for the postoperative analgesia to use the continuous epidural injection with DIB Catheter for patients after lower extremity arthroplasty. It was necessary to give a bolus injection of buprenorphine before the end of surgery for sufficient analgesia, but it was not necessary to add local anesthetics in the content of DIB Catheter.

Topics: Adult; Aged; Aged, 80 and over; Analgesia, Epidural; Analgesics, Opioid; Anesthesia, Epidural; Arthroplasty, Replacement; Buprenorphine; Female; Humans; Injections, Epidural; Male; Middle Aged; Pain, Postoperative; Treatment Outcome

The purpose of the study was to compare the analgesic and side effects of two epidurally administered mixtures of bupivacaine and fentanyl with the same drug ratios.. One hundred patients scheduled for colorectal surgery were randomized to receive a thoracic epidural infusion of either bupivacaine 0.12% with fentanyl 2 micrograms/ml or bupivacaine 0.24% with fentanyl 4 micrograms/ml during 48 h postoperatively. The pumps were adjusted to keep the visual analogue scale (VAS) pain score at 3 or less (on a scale of 0-10) with a minimum of adverse effects.. There were no statistically significantly differences between the two groups in VAS pain scores. The average VAS pain score resting varied between 0.5 and 1, and coughing between 1.9 and 3.4. One case of respiratory depression with breathing frequency 7 occurred in each group, but none of the patients required naloxone. One patient in the low concentration group developed partial motor weakness in both legs 36 h postoperatively. Equal drug amounts--bupivacaine 10.8-11 mg/h and fentanyl 18-18.4 micrograms/h--were given in both groups throughout the study.. Both groups had low pain scores with few and comparable adverse effects. It thus seems that the volume is not important when mixtures of bupivacaine and fentanyl in the studies concentrations are infused epidurally at a low thoracic level. Practical reasons favour the higher concentration mixture.

Topics: Aged; Analgesia, Epidural; Analgesics, Opioid; Anesthetics, Local; Bupivacaine; Buprenorphine; Colon; Cough; Fentanyl; Follow-Up Studies; Humans; Infusion Pumps; Injections, Intravenous; Leg; Middle Aged; Muscle Weakness; Naloxone; Narcotic Antagonists; Pain Measurement; Pain, Postoperative; Rectum; Respiration

Sixty cats which underwent an ovariohysterectomy were randomly allocated into four treatment groups. One group (controls) received no analgesics postoperatively, and the others received either a single dose of buprenorphine (0.006 mg/kg) intramuscularly, or pethidine (5 mg/kg) intramuscularly, or ketoprofen (2 mg/kg) subcutaneously. The analgesia obtained after each treatment was assessed by three measures. There were significant differences between the groups both for the requirement for intervention analgesia (P = 0.0008) and for the overall clinical assessment (P = 0.0003) with ketoprofen requiring least intervention analgesia and having the best overall clinical assessment, followed by buprenorphine then pethidine. The control group required the most intervention analgesia and had the worst overall clinical assessment. Visual analogue scale scoring for pain produced significant differences between the groups from one hour after the operation, with the cats which were given ketoprofen tending to have lower pain scores than the other groups.

Topics: Analgesia; Animals; Buprenorphine; Cat Diseases; Cats; Female; Hysterectomy; Ketoprofen; Meperidine; Ovariectomy; Pain, Postoperative; Postoperative Care

There is limited information regarding the effects of epidural or intravenous (i.v.) buprenorphine on minimum alveolar anesthetic concentration (MAC) of volatile anesthetic and hemodynamic responses to tracheal intubation and surgical incision. This study was conducted to find the effects of i.v. and epidural buprenorphine required for postoperative pain relief on halothane MAC and hemodynamic responses to tracheal intubation and surgical incision in 126 female patients. Patients were randomly assigned to the four groups: Group I received i.v. and epidural saline as a control; Group II was given buprenorphine 4 micrograms/kg i.v.; and Groups III and IV received buprenorphine 2 and 4 micrograms/kg epidurally, respectively. Groups II-IV were divided into the two subgroups according to the timing of administration, either at induction of anesthesia in the operating room (OR) (OR group) or 90 min before anesthetic induction in the ward (Ward group). Anesthesia was induced with only halothane in oxygen, and the trachea was intubated without other drugs. Halothane MAC was determined by logistic regression analysis and the Dixon up-and-down method. Halothane MAC in the seven study groups was as follows: 0.75% +/- 0.05% (mean +/- SE) in Group I; 0.49% +/- 0.03% and 0.59% +/- 0.04%, respectively, in Groups II OR and Ward; 0.65% +/- 0.003% and 0.49% +/- 0.07%, respectively, in Groups III OR and Ward; and 0.51% +/- 0.07% and 0.37% +/- 0.02%, respectively, in Groups IV OR and Ward. Halothane MAC decreased significantly (P < 0.05) in groups that received buprenorphine except Group III-OR compared with Group I. Systolic blood pressure did not change significantly in Groups II-OR and IV-OR after tracheal intubation and in Group III-Ward and IV-Ward after surgical incision but increased significantly (P < 0.05) in the remaining groups in response to noxious stimuli. Heart rate responses to tracheal intubation and surgical incision were similar to those in systolic blood pressure. These results indicate that preanesthetic administration of epidural or IV buprenorphine required for postoperative analgesia reduces halothane MAC and attenuates hemodynamic responses to tracheal intubation and surgical incision according to the dose, route, and timing of administration.

Topics: Adult; Analgesics, Opioid; Anesthesia, Inhalation; Anesthetics, Inhalation; Blood Pressure; Buprenorphine; Female; Halothane; Heart Rate; Hemodynamics; Humans; Hysterectomy; Injections, Epidural; Injections, Intravenous; Intubation, Intratracheal; Middle Aged; Pain, Postoperative; Preanesthetic Medication; Prospective Studies; Pulmonary Alveoli

To compare three analgesic regimens for pain relief after thyroidectomy.. Randomized, double-blind, placebo-controlled study.. Inpatient anesthesia in a university department of endocrine surgery.. 342 patients scheduled for elective thyroidectomy with nitrous oxide-oxygen-isoflurane anesthesia in addition to fentanyl.. Group 1 received preoperative oral controlled release morphine 10 mg, and Group 2 received postoperative sublingual buprenorphine 0.2 mg. Group 3 received 0.25% bupivacaine (10 ml) wound infiltration before skin closure. Eight hours after tracheal extubation, patients received a second dose of the same drug in each group except in Group 3, where medication was changed to sublingual buprenorphine 0.2 mg.. Patients in Group 2 required fewer additional analgesics: 0.54 +/- 0.68 vs. 0.96 +/- 0.84 in Group 1 and 0.79 +/- 0.78 in Group 3. Patients in Group 2 demonstrated a better pain score and this group showed a higher percentage of satisfied patients: 96% vs. 85% in Group 1 and 91% in Group 3. Group 2 also included more patients requiring no analgesics: 56% vs. 32% in Group 1 and 42% in Group 3. The side effects in all three groups did not differ.. The administration of sublingual buprenorphine after thyroidectomy provides better analgesia than small doses of oral controlled-release morphine or than 0.25% bupivacaine wound infiltration at the end of surgery.

Topics: Administration, Sublingual; Administration, Topical; Analgesics, Opioid; Anesthetics, Local; Bupivacaine; Buprenorphine; Delayed-Action Preparations; Double-Blind Method; Female; Humans; Male; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Thyroidectomy

For 120 young patients who had undergone reconstruction of anterior cruciate ligament of the knee, we investigated the effect of epidural administration of buprenorphine on the incidence of nausea or vomiting, and the anti-emetic effect of epidural administration of droperidol. In the group who had received bolus injection of buprenorphine 0.1 mg, nausea or vomiting occurred early most often, and the injection was not useful to prolong analgesic effect. In the another group who had received continuous epidural infusion of buprenorphine 0.3 mg, nausea or vomiting occurred late. Bolus injection of droperidol 2.5 mg was not useful to prevent nausea or vomiting caused by continuous epidural infusion of buprenorphine. While, continuous infusion of droperidol 5 mg was effective in decreasing nausea or vomiting caused by continuous epidural infusion of buprenorphine. In conclusion, continuous epidural administration of droperidol is useful to prevent nausea or vomiting.

Topics: Adolescent; Adult; Analgesics, Opioid; Anesthesia, Epidural; Anesthesia, General; Anterior Cruciate Ligament; Antiemetics; Buprenorphine; Droperidol; Female; Humans; Injections, Epidural; Male; Nausea; Pain, Postoperative; Vomiting

The aim of this study was to compare morphine with the partial agonist, buprenorphine, for postoperative analgesic effects, when administered preoperatively for elective arthrotomy in dogs. Fifty two dogs were anaesthetized for stifle, elbow, or hock arthrotomy. The dogs were premedicated 30 min prior to induction of anaesthesia with 0.03 mg/kg acepromazine intramuscularly, and either 0.3 mg/kg morphine or 0.01 mg/kg buprenorphine intramuscularly (allocated randomly). Anaesthesia was induced with thiopentone and maintained with halothane in an oxygen/nitrous oxide mixture. Pain and sedation were assessed preoperatively, and 0.5, 1, 2, 3, 5, and 7 h after the halothane was switched off, with a visual analogue scale scoring system. Pain scores did not differ significantly (morphine group median postoperative score from 30 to 40 mm, buprenophine group median postoperative score from 36 to 43 mm) and analgesia was considered adequate in the majority of cases (score less than 40 mm). Morphine produced significantly more sedation at 0.5 h after anaesthesia only. It was concluded that both opioids are equally suitable analgesics for postoperative analgesia for the elective arthrotomy in dogs.

Topics: Analgesia; Analgesics, Opioid; Anesthesia; Animals; Buprenorphine; Dogs; Elective Surgical Procedures; Female; Male; Morphine; Orthopedics; Pain, Postoperative; Preanesthetic Medication

Satisfactory pain relief with postoperative extradural bupivacaine increases the amount of breast feeding after Caesarean section. To investigate the effect of extradural buprenorphine, we have evaluated the amount of breast feeding and the gain in infant weight for 11 days after Caesarean section in patients who received continuous extradural bupivacaine with or without buprenorphine. Extradural buprenorphine significantly decreased both measures although there was no significant difference in pain intensity. We suggest that extradural buprenorphine suppressed breast feeding after Caesarean section.

Topics: Analgesia, Epidural; Analgesics, Opioid; Breast Feeding; Bupivacaine; Buprenorphine; Cesarean Section; Feeding Behavior; Female; Humans; Infant, Newborn; Pain, Postoperative; Pregnancy; Weight Gain

Extradural administration of combinations of local anaesthetics and opioids are frequently employed for postoperative pain relief. There is a scarcity of data on the analgesic effects of variations of the dose of local anaesthetic drug admixed to a fixed dose of opioid.. Twenty-four patients were investigated after elective upper abdominal surgery. During closure of the abdomen, 2% mepivacaine (8 ml) with buprenorphine 0.1 mg (0.5 ml) was given extradurally. After extubation, patients were randomly allocated to receive continuous extradural infusion of a fixed dose of buprenorphine (0.017 mg/h) in combination with 2% lignocaine at either 2.1 ml/h (low rate group, n = 14) or 6.3 ml/h (high rate group, n = 10). Postoperative pain at rest was assessed using visual analogue scale (VAS) scores and pain at movement by Prince Henry Pain Scale (PHPS) scores. Venous plasma lignocaine concentrations were measured.. VAS scores at rest were similar in the two groups at 3 h postoperatively, whereas at 6-24 h postoperatively, VAS scores were higher in the low rate group than in the high rate group. PHPS scores were similar in the two groups at 3 h and at 18 h postoperatively, whereas at 6, 9, 12 and 24 h postoperatively, PHPS scores were higher in the low rate group than in the high rate group. Plasma lignocaine concentrations were higher at 23 h postoperatively in the high rate group than at 16 h in both groups, and at 23 h in the low rate group. At 3 h postoperatively, both the systolic and diastolic arterial pressures were higher in the low rate group than control values obtained on admission. Side effects were observed in one patient in the low rate group who complained of dizziness, and in one patient in the high rate group who complained of nausea.. When added to a fixed dose of buprenorphine, continuous extradural infusion of 2% lignocaine at high rate provides better postoperative analgesia than when given at low rate without producing significant side effects.

Topics: Abdomen; Analgesia, Epidural; Analgesics, Opioid; Anesthetics, Local; Buprenorphine; Female; Humans; Lidocaine; Male; Mepivacaine; Middle Aged; Pain Measurement; Pain, Postoperative; Prospective Studies

In comparison to conventional operating technique endoscopic surgery reveals numerous advantages, particular rapid mobilisation and earlier discharge from observation. For a effective utilization of these advantages, it is desirable to have a efficient postoperative analgesic scheme, which can be continued into the period after discharge from hospital. In a randomised, prospective double-blind study we investigated the analgesic efficacy of dipyrone in 40 patients, scheduled for endoscopic abdominal surgery (mainly endoscopic cholecystectomy). Patients received before induction of anesthesia either dipyrone (1 g/100 ml NaCl i.v.) or placebo (100 ml NaCl i.v.). These infusions were repeated 6 h and 12 h after first application. After surgery all patients were allowed to self-administer buprenorphine intravenously from a PCA-pump (Bolus 30 micrograms, lockout 5 min in the recovery room, 30 min on the ward). Every hour for the first 6 h and after 24 h, cumulated doses of buprenorphine, pain scores (0-10), pulse, blood pressure and side effects were recorded. Dipyrone-treated patients had significantly less pain immediately after surgery and used a significantly lower cumulated dose of buprenorphine (-67%; 90 micrograms vs. 270 micrograms buprenorphine) in the first 24 h after surgery.

Topics: Adolescent; Adult; Aged; Analgesia, Patient-Controlled; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Cholecystectomy, Laparoscopic; Dipyrone; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Infusions, Intravenous; Laparoscopy; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Prospective Studies; Treatment Outcome

Nalbuphine (0.3 mg.kg-1) and buprenorphine (2.5 micrograms.kg-1) were compared as part of a total intravenous anaesthesia regimen using a propofol infusion in 60 patients undergoing laparoscopic cholecystectomy in a randomised double-blind study. Changes in haemodynamic variables greater than 20% from the baseline were noted. No difference was observed in blood pressure but the heart rate was significantly lower in the buprenorphine group. Intra-operative bradycardia (heart rate < 60 beat.min-1) occurred more often in the buprenorphine group. Recovery was fast and comparable with both drugs and no patient reported awareness. Quality of analgesia was similar in both groups. Both drugs provide suitable analgesic supplementation to total intravenous anaesthesia.

Topics: Adult; Analgesics, Opioid; Anesthesia, Intravenous; Bradycardia; Buprenorphine; Cholecystectomy, Laparoscopic; Double-Blind Method; Drug Administration Schedule; Hemodynamics; Humans; Middle Aged; Nalbuphine; Pain, Postoperative; Patient Satisfaction; Postoperative Complications

The aim of this study was to evaluate the analgesic effect of PCA buprenorphine (intravenous) on postoperative pain in gynecologic patients of Taiwan and the potency ratio of buprenorphine versus morphine, a commonly used potent analgesic.. Fifty women undergoing abdominal total hysterectomy under spinal anesthesia were enrolled into the investigation. Patients were randomly divided into 2 groups (n = 25 each). Group 1 received intravenous buprenorphine using PCA device for the management of postoperative pain, whereas Group 2 received PCA morphine for the same purpose. During the first 48 hours postoperatively, we collected the following data: demand and delivery of analgesics, pain scores, vital signs, nausea, vomiting and pruritus.. Despite different treatments, we found that pain scores on day 1 and day 2 postoperatively were low and were not significantly different between groups. Also, times of demand for delivery of PCA medication were not significantly different between groups. The cumulative consumption of buprenorphine and morphine within 48 h were 1.5 +/- 0.6 mg and 36 +/- 7 mg, respectively. The potency ratio between buprenorphine and morphine was 24:1. Both treatments showed only minor side effects.. We found that PCA buprenorphine (intravenous) could be effective in the treatment of postoperative pain in the gynecologic patients in Taiwan and the potency ratio of buprenorphine versus morphine appeared to be 24:1.

Topics: Analgesia, Patient-Controlled; Analgesics, Opioid; Buprenorphine; Female; Humans; Hysterectomy; Morphine; Pain, Postoperative

We conducted a randomized, double-blind trial to evaluate the early and late analgesic effect of preoperative wound infiltration with bupivacaine 0.25% (40 mL) compared to placebo (NaCl 0.9%, 40 mL) in patients undergoing major surgery. Forty-one patients scheduled for elective hysterectomy during general anesthesia were included. The pain management focused on pain prevention, including preoperative administration of nonsteroidal antiinflammatory drugs (NSAIDs), and peroperative administration of opioids. Postoperatively patients received buprenorphine and/or acetaminophen on demand. A significant difference between treatments was evident in the 3-day postoperative trial period. With identical pain scores in the two groups, the requested total amount of buprenorphine was greater in the placebo group (2.0 [0-5.1] mg) (median and [range]) than in the bupivacaine group (0.8 [0-2.8] mg) (P < 0.05). The demand for analgesics occurred earlier in those who received placebo (225 min) than in those who received bupivacaine (345 min), but did not reach the level of significance. In conclusion, preoperative wound infiltration with bupivacaine improved immediate and late postoperative pain management after hysterectomy compared to placebo.

Topics: Acetaminophen; Adult; Aged; Analgesics, Non-Narcotic; Analgesics, Opioid; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Bupivacaine; Buprenorphine; Dermatologic Surgical Procedures; Double-Blind Method; Elective Surgical Procedures; Female; Humans; Hysterectomy; Injections, Subcutaneous; Middle Aged; Pain Measurement; Pain, Postoperative; Placebos; Premedication

We evaluated the effects of suppositories of buprenorphine (BN) or NSAID (supp.) preoperatively administered for postoperative pain relief in patients who underwent elective gynecological surgeries. Fifty six patients were randomized into four groups: group B; 0.4 mg BN supp., group B+I; 0.4 mg BN supp. and 50 mg indomethacine (IND) supp., group B+D; 0.4 mg BN supp. and 50 mg diclofenac supp., group C; no supp. given as control. They were administered rectally after induction of general anesthesia. In all the supp. groups the patients had good pain relief during the first 24 hrs after the administration of supp. Group B+I seemed to have better pain relief, but, there was no statistical significance among the 3 groups. Nausea and vomiting were observed more frequently in group B and in control group C than in NSAIDs combined groups. The difference in the incidence rates was not significant. In conclusion, the simultaneous administration of BN and IND supp. was considered to be useful for postoperative pain relief without producing major side effects.

Topics: Adult; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Diclofenac; Female; Humans; Indomethacin; Middle Aged; Pain, Postoperative; Suppositories

To compare the analgesic effect of subcutaneous buprenorphine alone and in combination with propacetamol and ketoprofen following urologic surgery.. Open randomized clinical trial.. Sixty ASA II/III patients undergoing urologic surgery.. The patients were randomized into three groups to receive either buprenorphine (0.3 mg subcutaneous) on demand (group 1, n = 20), or a combination of buprenorphine (0.3 mg)-propacetamol (2 g)-ketoprofen (100 mg) by intravenous route over 2 hours followed by an infusion of propacetamol (2 g) and ketoprofen (100 mg) at a constant rate over. The remaining 22 hours (group 2, n = 20), or the same loading dose as in group 2 prolonged by a continuous infusion of buprenorphine (0.3 mg), propacetamol (2 g) and ketoprofen (100 mg) over the same period (group 3, n = 20). Visual analogue scale pain scores (0-10) were assessed every hour during the 24 hours of the study. When the VAS score exceeded 5, an additional dose of 0.3 mg of buprenorphine was administered.. Groups were similar for age, surgery, anaesthesia and initial pain levels. Compared to group 1, the onset of analgesia was earlier in groups 2 and 3 at the 1st hour (P < 0.05); the level of analgesia was lower at the 3rd hour (P < 0.05). The maintenance of this analgesia level required constant buprenorphine administration. Buprenorphine requirements were decreased to 56% and 37% in groups 2 and 3 respectively, compared to group 1 (P < 0.05). Incidence of nausea and vomiting was lowered to 15% in group 3 (P < 0.05).. A combination of buprenorphine, propacetamol and ketoprofen provides effective postoperative analgesia with a low incidence of nausea and vomiting and decreased requirements of buprenorphine.

Topics: Acetaminophen; Adult; Aged; Aged, 80 and over; Analgesics; Buprenorphine; Drug Therapy, Combination; Female; Humans; Ketoprofen; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Urologic Diseases

Using a portable 0.5 ml.h-1 type infuser with Patient Control Module (Baxter infuser BB+ PCM), we compared patients receiving continuous epidural infusion with patients using self controlled analgesia system for postoperative analgesia after upper abdominal surgery. Twenty-one patients were randomized into three groups: group I (n = 7) received 20 micrograms.h-1 of buprenorphine (Bu) with additional 20 micrograms of Bu; group II (n = 7) 20 micrograms.h-1 of Bu plus 1 mg.h-1 of bupivacaine (Bup) with additional 20 micrograms of Bu plus 1 mg of Bup; group III (n = 7) 20 micrograms.h-1 of Bu plus 2 mg.h-1 of Bup with additional 20 micrograms of Bu plus 2 mg of Bup. In all three groups, patients received supplemental Bu 0.1 mg intramuscularly as needed. During 48-hours postoperatively, we evaluated verbal descriptor pain scale, sedative scale, visual analogue scale, supplemental doses of Bu, and side effects. Total doses of Bu during the first 12 hours were significantly larger than those during other 12-hour period in all the groups (P < 0.05). In each period during the 12 to 48-hours after operation, the percentage of the patients who needed no supplemental Bu was 71.4-100%, which is higher than during the 0 to 12-hours (47.7%). There was no significant difference in verbal descriptor pain scale, sedative scale, visual analogue scale, and the incidence of side-effect among the three groups. Continuous epidural infusion with Bu using a portable 0.5 ml.h-1 type infuser with patient control module was effective for alleviating postoperative pain except in the first 12-hour period. However, addition of Bup to Bu did not improve the quality of postoperative epidural analgesia.

Topics: Aged; Analgesia, Epidural; Bupivacaine; Buprenorphine; Drug Combinations; Female; Gastrectomy; Humans; Infusion Pumps; Male; Middle Aged; Pain, Postoperative; Self Administration

Continuous intravenous infusions of fentanyl, buprenorphine or nalbuphine were investigated to provide pain relief for patients after major abdominal surgery. Buprenorphine (n = 23) was given as a loading dose of 5 micrograms kg-1 and infused at 0.8 micrograms kg-1 h-1. Fentanyl (n = 20) was given as a loading dose of 2 micrograms kg-1 and infused at 0.7 micrograms kg-1 h-1. Nalbuphine (n = 21) was given as a loading dose of 200 micrograms kg-1 and infused at 80 micrograms kg-1 h-1. The infusion rate was increased when analgesia was inadequate, and decreased if respiratory depression occurred. Mean doses were respectively 0.74 +/- 0.15 microgram kg-1 h-1 buprenorphine, 0.68 +/- 0.18 microgram kg-1 h-1 fentanyl, 83 +/- 21 micrograms kg-1 h-1 nalbuphine. Titration of continuous intravenous infusion of buprenorphine and fentanyl provided better analgesia than nalbuphine with smaller doses than those reported in similar studies allowing spontaneous breathing.

Topics: Adult; Aged; Analgesia; Analgesics, Opioid; Buprenorphine; Female; Fentanyl; Humans; Infusions, Intravenous; Male; Middle Aged; Nalbuphine; Pain, Postoperative; Prospective Studies

Transcutaneous cranial electrical stimulation with Limoge's currents (TCES) consists of high frequency, low intensity currents which decreased anesthetic requirements during elective surgery. This action is likely to be mediated by the release of central endogenous opioids. In the present study, we hypothesized that TCES applied intraoperatively may decrease early postoperative narcotic requirements. Thirty-nine ASA physical status I and II patients undergoing elective abdominal surgery were enrolled in this prospective, randomized, double-blind, placebo-controlled study. Just before induction of anesthesia, patients were connected to the electrical stimulator and randomly allocated to be either stimulated (TCES group, n = 20) or not (control group, n = 19) during surgery. The managing anesthesiologist was unaware of which group the patient was assigned. Postoperatively, patients were given a patient-controlled analgesia (PCA) device delivering buprenorphine for the first four postoperative hours. The recorded variables included postoperative buprenorphine requirements, pain scores (0-10 visual analog scale [VAS]), sedation (0-4 scale), and intraoperative isoflurane requirements. Patients were comparable with respect to age, sex ratio, weight, duration of surgery, intraoperative hemodynamics, fentanyl requirements, and time from skin closure to tracheal extubation. Buprenorphine requirements were significantly reduced in the TCES group versus the control group (2.36 vs 3.43 micrograms.kg-1.h-1; P = 0.002). Intraoperative isoflurane anesthetic requirements, as well as hourly postoperative scores for pain and sedation, were the same for the two groups. These data indicate that TCES reduces narcotic requirements for early postoperative analgesia. This technique might have potential to facilitate early postoperative analgesia in patients undergoing elective abdominal surgery.

Topics: Abdomen; Analgesia, Patient-Controlled; Analgesics, Opioid; Anesthetics, Inhalation; Anesthetics, Intravenous; Buprenorphine; Conscious Sedation; Double-Blind Method; Elective Surgical Procedures; Electronarcosis; Female; Fentanyl; Humans; Infusion Pumps; Intraoperative Care; Intubation, Intratracheal; Isoflurane; Middle Aged; Pain Measurement; Pain, Postoperative; Placebos; Prospective Studies

To study the effect of epidural buprenorphine on minimum alveolar concentration (MAC) of volatile anaesthetics, duration of analgesia and respiratory function in the perioperative period.. One hundred and twenty patients, ASA I-II undergoing gynaecological surgery were randomly divided into three studies. The forty patients in each study were randomly divided into four groups depending on the dosage; Group I (control), Group II (80 micrograms. kg-1 morphine), Group III (4 micrograms. kg-1 buprenorphine), Group IV (8 micrograms. kg-1 buprenorphine). The MAC of halothane was measured following epidural administration of the agents in each group. The duration of analgesia was assessed by the first request for pentazocine. Postoperative analgesic effects were assessed by the total dosage of pentazocine required for the 48 hr after surgery. Respiratory rate (RR), minute volume (MV), and PaCO2 were measured during surgery and the postoperative period. The MAC of halothane was reduced in Group IV (P < 0.01). The duration of analgesia was 10.0 +/- 5.1 hr (Mean +/- SE) in Group I, 37.7 +/- 4.7 hr in Group II, 27.1 +/- 7.1 hr in Group III, and 44.4 +/- 4.1 hr in Group IV. Total dosage of pentazocine was lower in Group IV (P < 0.05) than in the other groups. The decrease of RR, MV and the increase of PaCO2 were observed within 60 min in Group III and IV dose dependently.. Epidural buprenorphine administered in a dose of 4 or 8 micrograms. kg-1 provides postoperative analgesia that is no less effective than that of morphine.

Topics: Adult; Analgesia, Epidural; Analgesics, Opioid; Buprenorphine; Carbon Dioxide; Female; Halothane; Humans; Middle Aged; Pain, Postoperative; Respiration

We compared the efficacy of epidurally administered buprenorphine (0.2 mg) after combined spinal-epidural anesthesia (CSE group) and that after general anesthesia combined with epidural anesthesia (EPI + GEN group). Postoperatively epidural buprenorphine was administered for initial pain relief significantly later in CSE group than in EPI + GEN group. The duration of pain relief with epidural buprenorphine was similar in both groups (about 11 hours). The time period until postoperative first walk and the number of pain relief medication were also similar in both groups. We had the impression that the onset of pain relief was faster in CSE group, probably because there might be flux of buprenorphine through a dural hole just after epidural administration.

Topics: Analgesia, Epidural; Analgesics, Opioid; Anesthesia, Epidural; Anesthesia, General; Anesthesia, Spinal; Buprenorphine; Humans; Pain, Postoperative; Retrospective Studies

After open prostatectomy, 52 patients were randomly allocated to two treatment groups. Group A (26 patients) received buprenorphine sublingually, and in group B (26 patients) the analgesia was induced using a patient-controlled analgesia system with morphine. The total dose of morphine given during the first 24 h was 72 +/- 8 mg compared to 1.6 +/- 0.45 mg of buprenorphine. The total dose of buprenorphine on days 2 and 3 was significantly lower than the total dose of morphine (p < 0.01). There were no significant differences in visual pain scores, side effects, mean arterial blood pressure, pulse rate and respiration rate between the two groups. Sublingual application of buprenorphine offers an effective and easy alternative to the parenteral route of morphine for the management of postoperative pain.

Topics: Administration, Sublingual; Aged; Aged, 80 and over; Analgesia, Patient-Controlled; Analgesics, Opioid; Blood Pressure; Buprenorphine; Humans; Male; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Prostatectomy; Pulse; Respiration

A randomised double-blind placebo-controlled trial was undertaken to assess the analgesic efficacy of intra-articular opioids following arthroscopy of the knee. At the completion of surgery, patients received an intra-articular injection of: morphine 1 mg, buprenorphine 30 micrograms or 0.9% saline. There were no differences in pain scores among groups for the first 24 h postoperatively. We have found no clinical evidence for a peripherally-mediated opioid analgesic effect.

Topics: Adult; Ambulatory Surgical Procedures; Analgesics, Opioid; Arthroscopy; Buprenorphine; Double-Blind Method; Female; Humans; Injections, Intra-Articular; Knee Joint; Laparoscopy; Male; Middle Aged; Morphine; Pain, Postoperative

Caudal buprenorphine was investigated as a postoperative analgesic in a randomized double blind study in thirty children aged 5-12 years undergoing lower abdominal and lower limb surgery. Comparison was made between two groups of patients, one group receiving plain bupivacaine and the other a combination of plain bupivacaine with buprenorphine. Postoperative analgesia was assessed using a linear analogue scale, and by the response to direct questioning of children using an illustration of sequence of faces. Any untoward side effects and the need for additional analgesics were recorded. The degree and duration of analgesia was far superior in the buprenorphine group and there was a highly significant difference in the requirement of postoperative analgesia between the two groups. There were no major adverse side effects and no motor weakness in either groups, however the incidence of nausea and vomiting was higher in the buprenorphine group. It is concluded that a combination of bupivacaine with buprenorphine administered through the caudal epidural space is a safe and reliable means of providing postoperative pain relief in children for up to 24 h.

Topics: Abdomen; Analgesia, Epidural; Analgesics, Opioid; Anesthesia, Epidural; Anesthetics, Local; Bupivacaine; Buprenorphine; Child; Child, Preschool; Double-Blind Method; Humans; Incidence; Leg; Meperidine; Nausea; Pain Measurement; Pain, Postoperative; Time Factors; Vomiting

The study describes long term ventilatory effects of 50 or 100 micrograms.kg-1 of morphine or 1.5 or 3.0 micrograms.kg-1 of buprenorphine when given in repeated intravenous (i.v.) doses, in a double blind fashion, to achieve equal levels of analgesia after thoracotomy. The patients were 56 children, six months to six years of age. Ventilatory rate (VR) was measured over the 24 h study period, and arterial carbon dioxide tension (PaCO2) was measured on arrival in the Paediatric Intensive Care Unit (PICU) and at 1, 6, 12 and 18 h. In the buprenorphine groups VRs progressively decreased during the first 2 h and remained significantly lower (P < 0.05) than in the morphine groups for 7 h. For the rest of the study period there were no differences. The PaCO2 values did not differ significantly at any point. For safety, prolonged observation of children is needed after intravenous administration of buprenorphine to ensure the ventilatory rate has stabilized.

Topics: Analgesia; Analgesics, Opioid; Blood Pressure; Buprenorphine; Carbon Dioxide; Child; Child, Preschool; Critical Care; Double-Blind Method; Heart Rate; Humans; Infant; Injections, Intravenous; Morphine; Pain, Postoperative; Respiration; Safety; Thoracotomy

For the pain relief after thoracoscopic surgery, the epidural injection of buprenorphine was performed in 46 cases. In 28 cases, intermittent injection was performed before awaking from anesthesia. The effect was excellent in 6 cases, who were free from pain without any more injection after returning to the ward, and good in 27 cases, who sometimes felt dull pain and had another analgetics (intermittent epidural injection in 16 cases, intermittent epidural injection and another medication in 5 cases). In 18 cases, continuous injection was performed. The effect was excellent in 9 cases and good in 9 cases. It was concluded that the epidural injection had effective analgesic effect after thoracoscopic surgery, both in intermittent injection group and continuous injection group. For limited medication, the intermittent epidural injection was considered the first choice after thoracoscopic surgery.

Topics: Analgesia, Epidural; Analgesics, Opioid; Buprenorphine; Endoscopy; Humans; Injections, Epidural; Pain, Postoperative; Thoracoscopy

The effect of preoperative sublingual buprenorphine (B) on postoperative pain (VAS), the need for postoperative opioid injections and on time to discharge, was evaluated in a prospective randomised double-blind study. Forty ASA I-II patients scheduled for arthroscopy of the knee received premedication with 0.4 mg buprenorphine (group B) and 42 patients were given placebo (group P). Postoperatively, pethidine was given to patients with pain. Three of the 40 patients in group B vs 11 of the 42 in group P received pethidine (P < 0.05). In group B, however, 13 of the 40 patients complained of nausea, prolonging median time to discharge from 155 to 255 minutes (P < 0.05). In group P, 3 of the 42 patients were nauseated, P < 0.01, compared with group B. Time to discharge did not differ between the groups in patients without nausea. The median respiratory rate was significantly lower in group B, but no patient required ventilatory support. In conclusion, premedication with sublingual buprenorphine cannot be recommended for this procedure. It reduces the need for postoperative injections of pethidine but increases the incidence of postoperative nausea which prolongs the recovery time. Careful monitoring is also mandatory because of the possibility of respiratory depression.

Topics: Administration, Sublingual; Adolescent; Adult; Aged; Ambulatory Surgical Procedures; Analgesics, Opioid; Arthroscopy; Buprenorphine; Double-Blind Method; Humans; Meperidine; Middle Aged; Nausea; Pain, Postoperative; Premedication; Prospective Studies; Time Factors

The effect of 10 ml of intra-articular buprenorphine (0.30 mg) or normal saline on postoperative pain after shoulder surgery was studied in a randomized, prospective, double-blind study in 30 ASA I-II patients receiving general anaesthesia. The pain scores (Five Point Scale ranging from "no pain" to "unbearable pain" and Visual Analog Pain Scale) 1, 2, 3, 4, 6 and 24 hours after surgery, time to first analgesic use and total 6-hours and 24-hours analgesic requirements were recorded. VAPS was significantly lower in the buprenorphine group compared with placebo-treated patients one hour after surgery (p < 0.05). The time to first analgesic use was longer and total 6-h opioid requirements were lower in the buprenorphine group when compared with the control group (p < 0.05). No significant differences were detected in total 24-h analgesic requirements between the two groups. These results indicate that intra-articular injection of buprenorphine after shoulder surgery provides short analgesia. This effect may be mediated by systemic absorption.

Topics: Adolescent; Adult; Aged; Analgesics; Analgesics, Opioid; Buprenorphine; Double-Blind Method; Female; Humans; Injections, Intra-Articular; Joint Dislocations; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Shoulder Joint; Sodium Chloride

This investigation was conducted to determine the analgesic efficacy of rectal diclofenac coupled with continuous epidural infusion with buprenorphine and bupivacaine for pain relief after upper and lower abdominal surgery. Forty patients in control group received epidural buprenorphine 0.1 mg in 8 ml of 0.25% bupivacaine immediately after surgery and subsequently infusion was started with the solution of epidural buprenorphine 15 micrograms in 1 ml of 0.23% bupivacaine at a rate of 1 ml.h-1 for 48 h. Forty patients in study group received rectal diclofenac 50 mg immediately after surgery in addition to the same epidural injection method described above. Adding rectal diclofenac to continuous epidural infusion of buprenorphine and bupivacaine produced enhanced analgesia and reduced pain scores measured by VAS after upper abdominal surgery. However, after lower abdominal surgery, such effects of rectal diclofenac obtained after upper abdominal surgery were not demonstrable.

Topics: Abdomen; Administration, Rectal; Aged; Analgesia, Epidural; Bupivacaine; Buprenorphine; Diclofenac; Female; Humans; Male; Middle Aged; Pain, Postoperative; Suppositories

We investigated the proper dosage of droperidol continuously infused into the epidural space. Sixty patients who received continuous epidural infusion of buprenorphine for 24 hours were divided into four groups (Group I: only buprenorphine, Group II: 1.25 mg of droperidol added to buprenorphine, Group III: 2.5 mg of droperidol added to buprenorphine, Group IV: 5 mg of droperidol added to buprenorphine). No significant difference was observed in prevention of nausea and vomiting among 4 groups. But in group II, III and IV, there was a tendency of increased analgesic effects of buprenorphine. Especially in group III, the pain level was significantly lower and number of doses of bupivacaine was significantly fewer than in group I. In conclusion, droperidol 2.5 mg continuously infused into epidural space increases analgesic effects of buprenorphine.

Topics: Analgesia, Epidural; Buprenorphine; Droperidol; Drug Administration Schedule; Female; Humans; Pain Measurement; Pain, Postoperative

To evaluate postoperative analgesia and side effects of epidural buprenorphine, 60 patients after thoracotomy were divided into 6 groups. All patients received a bolus epidural administration of buprenorphine 0.1 mg in 8 ml of 0.25% bupivacaine. Following this epidural bolus, 10 patients in each group were given 0.25% bupivacaine alone (group A), buprenorphine 5 micrograms in 1 ml of 0.25% bupivacaine (group B), buprenorphine 8 micrograms in 1 ml of 0.25% bupivacaine (group C), buprenorphine 12 micrograms in 1 ml of 0.25% bupivacaine (group D), buprenorphine 15 micrograms in 1 ml of 0.25% bupivacaine (group E) or buprenorphine 18 micrograms in 1 ml of 0.25% bupivacaine (group F) with a portable disposable device at a rate of 1 ml.h-1 for 48 h. The percentages of patients who did not need additional narcotics for the first 24 hours postoperatively in group A, B, C, D, E, and F were 20%, 40%, 30%, 50%, 60%, and 70%, respectively. Those for the second 24 hours postoperatively in each group were 40%, 50%, 70%, 60%, 90%, and 90%, respectively. No significant difference in the incidence of side-effect was found among 6 groups. We concluded that optimal epidural doses of buprenorphine for post-thoracotomy pain relief are 15 and 18 micrograms.h-1 in the first and second 24 hours postoperatively, respectively.

Topics: Adult; Aged; Analgesia, Epidural; Bupivacaine; Buprenorphine; Drug Combinations; Female; Humans; Injections, Epidural; Male; Middle Aged; Pain, Postoperative; Thoracotomy

We examined the analgesic efficacy and side effects of continuous epidural infusion with buprenorphine in 340 surgical patients. The patients received epidural injection of 0.1 mg of buprenorphine in 8 ml of 0.25% bupivacaine immediately after surgery. The patients who underwent thoracotomy or intraabdominal surgery were subsequently infused with buprenorphine 15 micrograms in 1 ml of 0.25% buprenorphine at a rate of 1 ml.h-1 for 48 h. In the other kinds of surgery, patients were infused with buprenorphine 8 micrograms in 1 ml of 0.25% buprenorphine at a rate of 1 ml.h-1 for 48 h. The patients who did not need additional narcotics were 68% and 83% on the postoperative day 1 and 2, respectively. Visual analogue scale (VAS) was 22 +/- 2 mm at rest and 43 +/- 2 mm at movement on the postoperative day 1. Corresponding values on the postoperative day 2 were 16 +/- 2 mm and 37 +/- 2 mm, respectively. Nausea and vomiting were found in 12.4% of the patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analgesia, Epidural; Bupivacaine; Buprenorphine; Drug Combinations; Female; Humans; Injections, Epidural; Male; Middle Aged; Pain, Postoperative

In a double-blind, parallel group trial, 15 patients who were given a caudal injection of 1.8 mg kg-1 of bupivacaine after induction of anaesthesia, were compared with 15 patients in whom 7.2 mg kg-1 of buprenorphine was added to the same dose of bupivacaine, prior to knee or hip replacement surgery. The duration of analgesia was much longer (mean 606 min vs. 126 min P < 0.001) in those receiving added buprenorphine; mean morphine consumption in the first 24 h was halved (14 mg vs. 28 mg) and patient satisfaction greatly increased. There were no significant differences in the incidence of complications although the group which had added buprenorphine had a lower incidence of vomiting.

Topics: Aged; Aged, 80 and over; Analgesics, Opioid; Anesthesia, Caudal; Anesthetics, Local; Bupivacaine; Buprenorphine; Double-Blind Method; Drug Combinations; Female; Hip Prosthesis; Humans; Knee Prosthesis; Male; Middle Aged; Morphine; Nerve Block; Pain, Postoperative

We herein evaluated the analgesic effectiveness of low doses of buprenorphine with or without a primer and the practicality and usefulness of a constant flow disposable infusion set (Infusor Baxter 2 ml/h). Our series consists of 300 patients, seen between January 1992 and December 1993, randomly distributed in three groups of 100 patients each. All patients were informed before operation about the use of pain Visual Analogical Scale (VAS) and how the infusor works. At the end of the operation all patients had an infusor positioned with a 0.01 mg/kg supplied of buprenorphine diluted to 60 ml with Ringer's Lactate solution. In addition to this, group B patients received an i.v. primer of 0.003 mg/kg of buprenorphine diluted to 10 ml with saline solution and group C patients received an i.v. primer of 0.5 mg/kg of ketorolac diluted to 10 ml with saline solution. VAS, systolic arterial pressure, diastolic arterial pressure, heart rate, respiratory rate, request of analgesics and side effects were evaluated at one hour (T0), six hours (T1), 12 hours (T2), 24 hours (T3) and 36 hours (T4) after operation. Group B and C patients showed significant reduction in VAS compared to group A patients at T0 and T1 but the difference disappeared starting from T2. Group B and C patients showed blood pressure, heart rate and respiratory rate values significantly reduced compared to group A patients at T0 and T1. Such values however then stabilized. Side effects encountered were nausea and vomiting in different percentages in the three groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Analgesia, Patient-Controlled; Buprenorphine; Equipment Design; Female; Humans; Infusion Pumps; Infusions, Intravenous; Male; Middle Aged; Pain, Postoperative

The authors herein present their personal series on the clinical evaluation of the analgesic efficacy of 2 opiodes, peridural morphine hydrochloride (0.5 mg/kg) administered to group A patients, and sublingual buprenorphine (0.4 mg) administered to group B patients in the management of post-operative pain in major abdominal surgery. The study was conducted on 44 patients, both male and female, classified as ASA II and III. Statistical analysis of cardiovascular parameters (BP and cardiac frequency), respiratory frequency and pain score showed an overlapping progression among the two groups. Spontaneous pain decreased significantly to zero at T6 (p < 0.001). However, the necessity to administer buprenorphine more frequently after the sixth hour and the consequent increase in side effects, lead us to believe that the method used for group A patients is more advantageous.

Topics: Administration, Sublingual; Adult; Aged; Analgesia, Epidural; Buprenorphine; Female; Humans; Male; Middle Aged; Morphine; Pain, Postoperative

We examined the analgesic effects of indomethacin as an adjunct to postoperative epidural analgesia in 40 patients who underwent upper abdominal surgery. Twenty patients in control group were epidurally given 0.1 mg of buprenorphine in 8 ml of 0.25% bupivacaine immediately after surgery and subsequently infused 15 micrograms buprenorphine in 1 ml of 0.25% bupivacaine at a rate of 1 ml.h-1 for 48 h. The remaining 20 patients were rectally given 50 mg of indomethacin in addition to the same epidural method described above. The patients who did not need additional narcotics in the control and indomethacin groups were 45% and 80%, respectively (P < 0.05). In upper abdominal surgery, postoperative pain relief by epidural buprenorphine and bupivacaine plus rectal indomethacin was more effective than that by epidural buprenorphine and bupivacaine.

Topics: Abdomen; Administration, Rectal; Aged; Analgesia, Epidural; Bupivacaine; Buprenorphine; Drug Therapy, Combination; Female; Humans; Indomethacin; Male; Middle Aged; Pain, Postoperative

We conducted a study comparing patients receiving continuous subcutaneous administration of analgesia with self controlled analgesia system (CSAA group) with those receiving continuous epidural infusion (Epi group) for postoperative analgesia after abdominal surgery. Fourteen patients were randomized into two groups: CSAA group (n = 7) received 20 micrograms.h-1 of buprenorphine (Bu) subcutaneously with additional 20 micrograms of Bu using Baxter infusor BB+PCA; Epg group (n = 7) received continuous epidural infusion of 0.4 mg of Bu and 46 ml of 0.25% bupivacaine daily (16.7 micrograms.h-1 of Bu) using Baxter infusor 2 ml.h-1 type. In both groups, patients received supplemental 0.1 mg of Bu subcutaneously as needed. During 48-hour postoperatively, verbal descriptor pain scale, sedative scale, visual analogue scale, supplemental doses of Bu, and side effects were evaluated. There was no significant difference of verbal descriptor pain scale, sedative scale, visual analogue scale, and supplemental doses of Bu between CSAA group and Epi group. Total doses of Bu during the first 12 hours postoperatively (CSAA group: 0.37 +/- 0.08 mg, Epi group: 0.30 +/- 0.08 mg) were significantly more than those during other 12-hour period in both groups (P < 0.05). There was no severe side effect in both groups. We conclude that continuous subcutaneous administration of analgesic was effective for postoperative analgesia, and almost the same analgesic effect was obtained as compared with continuous epidural analgesia. We calculated that the adequate dose of Bu subcutaneously during early postoperative period to be about 30 micrograms.h-1 of Bu.

Topics: Aged; Analgesia, Epidural; Analgesia, Patient-Controlled; Bupivacaine; Buprenorphine; Female; Humans; Male; Middle Aged; Pain, Postoperative

The purpose of this study was to evaluate repeated use of Drug Infusion Balloon catheter (DIBC) experimentally and clinically. 1. Experimental study: The changes in flow rate by repeated use of DIBC (40 ml.12 h-1 type) were measured under room temperature (21 degrees C). 2. Clinical study: Ten patients scheduled for upper abdominal surgery were studied. DIBC (40 ml.12 h-1 type) was filled with midazolam, buprenorphine, and lidocaine. Twelve hours later, the same DIBC was filled with buprenorphine and lidocaine. The mean flow rates were, on first use; 2.91 +/- 0.51, on the second use; 2.88 +/- 0.45, on the third use; 2.75 +/- 0.44, and on the fourth use; 2.69 +/- 0.38 (ml.h-1, mean +/- SD, n = 6, P < 0.05). In the clinical study, pain scores, rates of supplemental analgesic infusion during 0-12 h period were not different from those during 12-24 h period. No complications were observed in this study. Repeated use of DIBC up to four times yielded reproducible results (+/- 8%). Repeated use of DIBC for postoperative pain relief, changing the contents according to the severity of pain, might be a useful and cost saving method.

Topics: Adult; Analgesia, Epidural; Buprenorphine; Catheterization; Humans; Infusion Pumps; Lidocaine; Midazolam; Middle Aged; Pain, Postoperative

Buprenorphine suppository (BSP) has been available as an analgesic agent in Japan since 1990. It has gained considerable popularity in various clinical situations; however, its usefulness for postoperative pain relief has been controversial. The present study is addressed to postoperative pain in fifty-seven women who underwent transvaginal hysterectomy under spinal anesthesia with tetracaine and phenylephrine. We examined the analgesic effects of buprenorphine (0.4 mg) suppository. Patients were divided into four groups according to the timing of buprenorphine suppository administration: group A1, preoperative administration of BSP, n = 12; group A2, postoperative administration of BSP, n = 17; group A3, intravenous injection of 0.1 mg of buprenorphine during surgery and postoperative administration of BSP, n = 14; group C, control group, n = 14. All the patients in group C complained of pain within 24 hr. The onset time of pain after surgery was significantly longer in patients in group A1 (372 +/- 220 min) and A3 (481 +/- 161 min) than in control group C (282 +/- 97 min). The percentage of patients who did not complain of pain within 24 hr was the largest in group A3 (36%). However there were no significant differences in age, body weight, effective analgesic time, analgesic level or operation time among the four groups. Nausea and vomiting were observed in all groups: C (36%), A1 (41%), A2 (18%), and A3 (29%). From these results, we conclude that preoperative or intraoperative administration of buprenorphine is useful for control of postoperative pain; the method of administration of buprenorphine suppository needs further study.

Topics: Adult; Buprenorphine; Female; Humans; Hysterectomy, Vaginal; Intraoperative Care; Middle Aged; Pain, Postoperative; Suppositories

We report an anesthetic management of a 45 year-old female patient with dystrophia myotonica who was scheduled for abdominal total hysterectomy. The patient was diagnosed as dystrophia myotonica 8 years ago. Epidural catheterization was performed through Th12-L1 interspace and spinal anesthesia was performed through L2-3 interspace using 3.3 ml of 0.5% bupivacaine. Adequate block below Th5 level was obtained. The intraoperative course of anesthesia was uneventful. Moreover, the continuous epidural administration of buprenorphine gave a satisfactory postoperative pain relief and no respiratory depression was observed. Spinal or epidural anesthesia seems to be effective and safe for the patient with dystrophia myotonica.

Topics: Anesthesia, Epidural; Anesthesia, Spinal; Buprenorphine; Female; Humans; Hysterectomy; Leiomyoma; Middle Aged; Muscular Dystrophies; Pain, Postoperative; Uterine Neoplasms

Buprenorphine and indomethacin are quite different pharmacologically. The objective of this study was to determine the analgesic effect from their combined administration in suppository form. Eighty patients undergoing open cholecystectomy under nitrous oxide-oxygen-sevoflurane anesthesia, in addition to epidural anesthesia using lidocaine, were divided into four groups: Group A received buprenorphine 0.4 mg and indomethacin 50 mg; Group B, buprenorphine 0.4 mg; Group C, indomethacin 50 mg; and Group D, no drug. The drugs were administered after induction of general anesthesia. One patient was withdrawn because of the administration of the wrong drug. Patients in Group A required fewer analgesics, had a longer period of analgesic effect from the end of surgery, and enjoyed a better pain score. This group also included more patients who required no analgesics. We conclude that the combined administration of opioid and nonopioid suppositories may provide far better prophylactic analgesia than a single drug.

Topics: Anesthesia, Epidural; Buprenorphine; Cholecystectomy; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Indomethacin; Intraoperative Period; Lidocaine; Male; Middle Aged; Pain, Postoperative; Premedication; Prospective Studies; Suppositories

In immediate postoperative period, many injectable analgesics are being used with diverse side effects. The present study was conducted on 75 patients of both sexes, who underwent various types of surgery, to evaluate pain relief in immediate postoperative period. The drugs used for producing postoperative analgesia are buprenorphine, pentazocine and nefopam, all by intramuscular route.

Topics: Adolescent; Adult; Buprenorphine; Female; Humans; Injections, Intramuscular; Intraoperative Period; Male; Middle Aged; Nefopam; Pain Measurement; Pain, Postoperative; Pentazocine; Time Factors

We evaluated the efficacy of epidural patient-controlled analgesia (PCA) with pethidine or buprenorphine plus 0.25% bupivacaine for postoperative analgesia after laparotomy with a midline incision under general anesthesia. Twenty patients were randomly allocated to two groups. In one group (PCEA-P group; n = 10), epidural pethidine plus 0.25% bupivacaine by PCA with 5 mg of pethidine and 2.5 ml of 0.25% bupivacaine bolus with a lockout interval of 20 min was added to a continuous epidural infusion of 0.25% bupivacaine (2 ml.h-1) plus pethidine (100 mg.24h-1) for 72 h. In the other group (PCEA-B group; n = 10), epidural buprenorphine plus 0.25% bupivacaine by PCA with 0.03 mg of buprenorphine and 2.5 ml of 0.25% bupivacaine bolus with a lockout interval of 20 min was added to a continuous epidural infusion of 0.25% bupivacaine (2 ml.h-1) and buprenorphine (0.6 mg.24 h-1) for 72 h. Analgesia was evaluated by 100 mm visual analog scale and verbal descriptor scale. In PCEA-B group, 90% of the patients did not complain of pain at rest, and in PCEA-P group, all the patients did not complain of pain at rest for 72 h. There were no significantly different analgesic effects between PCEA-P and PCEA-B for 48 h. The average doses of epidural PCA were 1.9 mg.kg-1.24 h-1 of pethidine, and 0.012 mg.kg-1.24 h-1 of buprenorphine, respectively. We conclude that PCEA-P and PCEA-B were effective for postoperative pain to the same degree for the first 48 h, but PCEA-P was superior to PCEA-B for the last 24 h.

Topics: Abdomen; Analgesia, Epidural; Analgesia, Patient-Controlled; Bupivacaine; Buprenorphine; Female; Humans; Male; Meperidine; Middle Aged; Pain Measurement; Pain, Postoperative

The aim of this single-dose, randomized, positive control, double-dummy, double-blind, parallel group study was to compare oral bromfenac 10 and 25 mg with sublingual buprenorphine 0.2 and 0.4 mg for treatment of postoperative pain. We studied 91 patients with moderate or severe pain after general surgical or orthopaedic operations, using pain intensity, pain relief, adverse effect, mood and sedation outcomes. There was a significant analgesic dose-response for buprenorphine, showing study sensitivity, but not for bromfenac. The two bromfenac treatments were significantly superior to the two buprenorphine treatments. Significantly more patients reported nausea with buprenorphine. There was evidence of a ceiling effect for analgesia with bromfenac.

Topics: Administration, Oral; Administration, Sublingual; Adolescent; Adult; Aged; Analgesics; Benzophenones; Bromobenzenes; Buprenorphine; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Male; Middle Aged; Pain, Postoperative

Three different post-operative pain relief schedules were investigated in a double blind study after total hip replacement. Group BS received a priming dose of buprenorphine i.m. at the time of wound closure and continued with sublingual buprenorphine every eight hours. Supplementary doses of buprenorphine i.m. could be demanded. Group B and M received a priming dose of buprenorphine and morphine respectively, and continued with sublingual placebo eight hourly. Supplementary doses of buprenorphine could be demanded by patients in Group B and supplementary doses of morphine by patients in Group M. On one occasion VAS scorings of groups BS and B were statistically significantly lower than group M, and on another occasion VAS scorings of group BS were statistically significantly lower than the other two groups. Furthermore, the number of on demand supplementary doses was statistically significantly higher in group M. It is concluded that buprenorphine administered at regular intervals as well as on demand provided better postoperative analgesia than morphine at present dose levels. In this context, only moderate advantages were obtained by administering buprenorphine at regular intervals.

Topics: Adult; Aged; Buprenorphine; Double-Blind Method; Hip Prosthesis; Humans; Injections, Intramuscular; Middle Aged; Morphine; Pain, Postoperative

Buprenorphine is an opioid agonist-antagonist that has emerged as an option for postoperative analgesia. We compared the postoperative hospital course of patients undergoing open cholecystectomy who received buprenorphine hydrochloride with those who received morphine sulfate. Patients in both groups administered the analgesic using a patient-controlled analgesia infusion device. Comparison of the two groups demonstrated no difference with respect to clinical indicators of intestinal motility, visual analog pain scores and hospitalization period. Postoperative nausea occurred more frequently in the buprenorphine group, but the difference was not significant. We concluded that the patient-controlled analgesia device is a valuable tool for comparing different analgesics. Both analgesics tested provide adequate analgesia with a similar postoperative course.

Topics: Adolescent; Adult; Aged; Analgesia, Patient-Controlled; Buprenorphine; Cholecystectomy; Female; Humans; Infusion Pumps; Male; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Prospective Studies; Single-Blind Method

This study was conducted on 44 children aged 1-10 years, who had undergone lower extremity orthopaedic surgery under general anaesthesia. Patients were divided into two groups: Group 1 (n = 23) received buprenorphine caudally and Group 2 (n = 21) received buprenorphine intramuscularly, at the completion of the surgery. The dose of buprenorphine used in both the groups was 4 micrograms.kg-1 body weight. The quality and duration of postoperative analgesia were evaluated by a single observer using a 5-point score for the first 24 h postoperatively. The time until the patient required postoperative analgesic was recorded. The duration of analgesia was significantly greater with caudal buprenorphine (median 20.20 h) than with intramuscular buprenorphine (median 5.20 h). Of the patients in the caudal group, 43% did not require any supplemental analgesia during the first 24 h, whereas all the patients in the intramuscular group required supplements within 10 h postoperatively. Caudal buprenorphine (4 micrograms.kg-1 body weight) provided 10.8 h to more than 24 h of analgesia in children, with fewer side effects.

Topics: Ambulatory Surgical Procedures; Analgesia, Epidural; Anesthesia Recovery Period; Buprenorphine; Child; Child, Preschool; Double-Blind Method; Female; Humans; Infant; Injections, Intramuscular; Leg; Male; Nausea; Pain Measurement; Pain, Postoperative; Time Factors; Vomiting

We have undertaken a double-blind, controlled study to test the hypothesis that the efficacy of standard postoperative analgesia by papaveretum or buprenorphine is not compromised by previous or subsequent standard doses of the other agent. After total abdominal hysterectomy under a standardized general anaesthetic, 120 patients (four groups of 30) were allocated randomly to receive, on demand, a single i.v. dose of buprenorphine 0.15 mg or papaveretum 10 mg, followed sequentially by a single dose of i.m. buprenorphine 0.3 mg or papaveretum 20 mg. Three hours after the i.m. dose, all patients received sublingual buprenorphine 0.4 mg. Pain was scored using both a 10-cm horizontal visual analogue scale (VAS) and a nominal scale. Pain intensity differences and patient and nurse satisfaction with the regimens were recorded. Observations were continued for 8 h after operation. The efficacy of papaveretum or buprenorphine was not compromised by previous or subsequent standard doses of the other agent. All four treatment regimens were similarly well tolerated and gave acceptable analgesia in the immediate postoperative period.

Topics: Adolescent; Adult; Aged; Buprenorphine; Double-Blind Method; Drug Interactions; Female; Humans; Hysterectomy; Injections, Intramuscular; Injections, Intravenous; Middle Aged; Opium; Pain Measurement; Pain, Postoperative; Time Factors

The efficacy of intramuscular (i.m.) buprenorphine, given either at the end of anaesthesia or to treat established pain was investigated on 60 patients scheduled for major abdominal surgery receiving isoflurane anaesthesia. During skin closure (1st injection), patients were given either i.m. buprenorphine 0.3 mg or i.m. saline. Pain was assessed every hour in the post-anaesthetic care unit by the patient using a numerical rating scale. Patients were given 0.3 mg of i.m. buprenorphine (2nd injection) on request. The study was completed when a 3rd injection of i.m. buprenorphine 0.3 mg was required. The overall impressions of patients, nurses and doctors were recorded on a scale ranging from 1 to 5 at the end of the study. The interval between the 1st and 2nd injection was significantly longer (P < 0.001) following administration of buprenorphine (5 h 18 min) than saline (1 h 3 min). Mean pain scores were significantly lower after buprenorphine compared to saline (P < 0.01). There was no significant difference in duration of action or mean pain scores following buprenorphine given either at wound closure or on first demand. However, overall impressions recorded at the end of the study were significantly better when buprenorphine was given preventatively. Prophylactic buprenorphine proved to be a suitable analgesic after an inhalational anaesthesia.

Topics: Abdomen; Adolescent; Adult; Aged; Buprenorphine; Double-Blind Method; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Pain, Postoperative

Sixty five children aged from 1-10 years who underwent herniotomy, cystolithotomy or orchidopexy received either buprenorphine 4 micrograms kg-1 (n = 33) or morphine 50 micrograms kg-1 (n = 32) by the caudal epidural route; each thus received 0.5 ml kg-1 body weight. General anaesthesia was given for surgery. Post-operative pain and behaviour were assessed by an independent observer at 1, 4, 8, 16 and 24 h post-operatively. Caudal morphine and buprenorphine were equally effective for post-operative analgesia in children, but buprenorphine was better because of its longer duration of action and lower incidence of side effects.

Topics: Anesthesia, Caudal; Buprenorphine; Child; Child, Preschool; Humans; Infant; Male; Morphine; Pain, Postoperative; Surgical Procedures, Operative

This study was a prospective, randomized comparison of the ventilatory effects of equianalgesic single-doses of morphine, 100 micrograms/kg, and buprenorphine, 3.0 micrograms/kg, administered intravenously to 20 children (5-8 years of age) after elective ophthalmic surgery. The decrease in ventilatory rate and acute change in the arteriolar oxygen saturation and the increase in end-tidal CO2 levels were statistically significantly greater in magnitude and duration after buprenorphine than after morphine. For both drugs, the time, duration and magnitude of ventilatory changes varied appreciably between individuals. No child had apnea or hypoventilation requiring assistance. The authors conclude that acutely administered buprenorphine depresses ventilation to a greater degree than morphine. The maximal ventilatory effect of buprenorphine occurs later than with morphine, and ventilatory depression after buprenorphine may develop late. For safety, all children given opioids intravenously should be observed until they are fully responsive and ventilatory control has stabilized.

Topics: Buprenorphine; Child; Child, Preschool; Eye Diseases; Humans; Morphine; Pain, Postoperative; Prospective Studies; Respiration

This study was undertaken to evaluate the effectiveness of 0.5% bupivacaine (360 mg/day) as a continuous infusion through an indwelling intercostal catheter inserted intraoperatively in the management of pain after thoracotomy. Eighty-six patients were randomized into three groups: group 1 = intercostal bupivacaine, group 2 = intercostal saline solution, and group 3 = fixed-schedule intramuscular buprenorphine. Supplementary buprenorphine was given as required. Pain and pulmonary function were assessed throughout the first 5 days after operation. Pain score was lower in group 1 than in group 2 for the first 8 hours after operation (p < 0.02). During the first 3 postoperative days, mean postoperative pain scores of 5 or more were recorded in 9% of group 1 patients versus 40% of group 2 patients (p < 0.05) and 13% of group 3 patients (not significant). Total doses of buprenorphine were lower in groups 1 and 2 than in group 3 (p < 0.001). No between-group differences in pulmonary function were observed. Respiratory complications occurred in no patients in groups 1 and 3 versus 5 in group 2 (p < 0.05). Continuous intercostal bupivacaine provided similar early pain control as compared with fixed-schedule narcotics but induced better analgesia with fewer complications than on-demand narcotics alone (group 2).

Topics: Analgesia; Bupivacaine; Buprenorphine; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Nerve Block; Pain, Postoperative; Thoracotomy

The authors compared the efficacy of ketorolac trometamin (30 mg i.m. every 6 hours) and buprenorphine (0.3 mg i.m. every 12 hours) in the treatment of pain following cholecystectomy. Ketorolac was found to be equally efficacious in comparison to buprenorphine and caused fewer side effects.

Topics: Adult; Aged; Analgesics; Buprenorphine; Cholecystectomy; Female; Humans; Ketorolac; Male; Middle Aged; Pain, Postoperative; Tolmetin

In a blinded, placebo-controlled study, the nonsteroidal antiinflammatory drug piroxicam, in combination with the partial morphine agonist/antagonist buprenorphine, was compared with buprenorphine alone for analgesic effect and side-effects in a 10-day period following total replacement of the hip or knee. 117 patients entered and 81 completed the study. The patients receiving piroxicam consumed less buprenorphine. There were no differences concerning side-effects between the two treatment groups, apart from a tendency towards less nausea after the third postoperative day in the group receiving piroxicam.

Topics: Buprenorphine; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Hip Prosthesis; Humans; Knee Prosthesis; Pain, Postoperative; Piroxicam

The efficacy for postoperative analgesia and side-effect of combined epidural infusion of bupivacaine and buprenorphine in comparison with each of these drugs alone were evaluated in 150 patients. All patients received initially bupivacaine 8 ml and buprenorphine 0.1 mg. In a random order, epidural infusion of 5 micrograms.ml-1 buprenorphine 1 ml.h-1 (group A; n = 50), 0.25% bupivacaine 1 ml.h-1 (group B; n = 50), or a combination of the two drugs 1 ml.h-1 (group C; n = 50) was continued for 48 h by a portable disposable device. The analgesic efficacy in group C was superior to that in group A or group B. No significant difference in the incidence of side-effect was found among the three groups. We conclude that epidural analgesia with the combination of buprenorphine and bupivacaine is safe, and easy to manage, giving pain relief superior to that provided by each of these drugs alone.

Topics: Adult; Aged; Analgesia, Epidural; Bupivacaine; Buprenorphine; Drug Combinations; Humans; Middle Aged; Pain, Postoperative

The intrapleural administration of local anesthetics via a catheter is a relatively new method for postoperative analgesia after thoracic and upper abdominal surgery. Many authors have described this technique as effective and with few side effects. METHODS. Intrapleural administration of bupivacaine (IPC group) was compared with intramuscular administration of buprenorphine in 26 patients who had undergone a cholecystectomy. During the 1st postoperative week the pulmonary function (vital capacity, forced expiratory volume in 1 s [FEV1]) and an arterial blood gas analysis were performed daily and the quality of analgesia was evaluated. RESULTS. The patients in the two groups were similar with regard to sex, age, weight, and height. The postoperative arterial oxygen partial pressure (pO2) did not differ significantly from the preoperative value in the IPC group, whereas in the opioid group the results were significantly lower than preoperatively (p less than 0.05 6 h after the operation and p less than 0.005 from the 1st to 7th postoperative days). There was a significantly higher pO2 in the opioid group preoperatively that, however, had no correlation with the differences between pre- and postoperative values. After the operation, the differences from the preoperative value were significantly smaller in the opioid group from the 1st to 7th postoperative days, reaching a significance of p less than 0.001 on the 2nd and 3rd, postoperative day. The pCO2 was slightly increased after the operation, but there were no significant differences between the groups. A significant decline in vital capacity and FEV1 occurred in both groups during the first days after the operation; there were no significant differences between the two groups during these days. The degree of pain was similar in the two groups before the analgesic was given. In both groups there was significant improvement of the degree of pain after administration of the analgesic. One hour after the injection, however, the degree of pain was significantly lower in the IPC group compared with the opioid group. Postoperatively, pathologic findings could be seen more often on chest X-rays in the opioid group, although there was no significant difference between the groups. There were no side effects caused by the intrapleural catheter or the local anesthetic except for a minor pneumothorax in 1 patient that did not need any treatment. CONCLUSION. The intrapleural administration of local anesthetic provide

Topics: Adult; Aged; Bupivacaine; Buprenorphine; Cholecystectomy; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Pain, Postoperative; Pleura

Sixty patients aged 50-65 years randomly received intrathecally either hyperbaric bupivacaine hydrochloride (one ml) in group A (30 cases) or bupivacaine hydrochloride (one ml) and buprenorphine 300 micrograms in combination in group B (30 cases). They were all scheduled for orthopaedic operations in the lower limbs. Prolonged postoperative analgesia, minimal disturbance of consciousness and respiration were observed in the group that received buprenorphine. The only side-effect found in the buprenorphine group was nausea and vomiting in 10 patients. This study shows that buprenorphine is an effective analgesic suitable for the management of postoperative pain in elderly patients.

Topics: Aged; Bupivacaine; Buprenorphine; Humans; Injections, Spinal; Male; Middle Aged; Orthopedics; Pain, Postoperative

In a double-blind, placebo-controlled study in 125 patients undergoing a cholecystectomy, a comparison was made of the quality of post-operative pain relief during 'patient-controlled' intake of sublingual buprenorphine in combination with either rectally administered naproxen 1000 mg/24 h, paracetamol 4000 mg/24 h or a placebo. Results obtained in 97 patients were analysed. Five of these patients needed a rescue medication with morphine hydrochloride intramuscularly because of insufficient pain relief or because of nausea and vomiting. The quality of pain relief, as measured on a four-point scale, was comparable in all three groups throughout the study period and no significant differences became apparent. Only on the day of surgery (day 0) was intake of buprenorphine significantly greater in the placebo group (2.3 tablets/24 h) than in the naproxen and paracetamol groups (1.8 and 1.5 tablets/24 h, respectively). It is concluded that after cholecystectomy 'patient-controlled' intake of sublingual buprenorphine as a sole agent provides acceptable pain relief in about 80% of patients. More elaborate methods, such as intravenous patient-controlled analgesia, might be necessary to achieve good pain relief in the remainder of these patients.

Topics: Acetaminophen; Administration, Sublingual; Adult; Aged; Analgesia, Patient-Controlled; Buprenorphine; Cholecystectomy; Double-Blind Method; Female; Humans; Male; Middle Aged; Naproxen; Pain, Postoperative

We compared the analgesia, side effects, and plasma concentrations of buprenorphine and fentanyl in a double-blind study of 78 parturients receiving one of these drugs by patient-controlled epidural infusion after elective cesarean section with epidural anesthesia. Patients were randomized to three epidural infusion groups: group 1 (n = 26), 3 micrograms/mL buprenorphine with 0.015% bupivacaine and 1 microgram/mL epinephrine; group 2 (n = 26), 3 micrograms/mL fentanyl with 0.015% bupivacaine and 1 microgram/mL epinephrine; and group 3 (n = 26), 3 micrograms/mL fentanyl with 0.015% bupivacaine. Plasma for determination of opioid concentrations was obtained in some subjects in each group at intervals up to 48 h during the infusion and in some subjects from each group at intervals after the infusion was stopped. Pain relief was similar and satisfactory in all three groups. The median overall satisfaction scores were high for all three groups. Pruritus was more common in the fentanyl groups (P less than 0.05). However, vomiting was more disturbing to the patients and seen only with buprenorphine. No patient had a respiratory rate less than 12 breaths/min. Epinephrine use was associated with a slower infusion rate (P less than 0.05, group 2 vs 3). All patients were able to ambulate without difficulty. Mean opioid plasma concentrations did not exceed 1.5 ng/mL. Thus, epidural patient-controlled analgesia in all three groups provided excellent analgesia, permitted ambulation, and was without serious side effects. Epidural buprenorphine offered no advantages over epidural fentanyl.

Topics: Analgesia, Epidural; Analgesia, Patient-Controlled; Bupivacaine; Buprenorphine; Cesarean Section; Epinephrine; Female; Fentanyl; Humans; Pain, Postoperative; Patient Satisfaction; Pregnancy; Random Allocation

A randomised study of the efficacy, duration of action and side-effects of two analgesic regimens following lower abdominal surgery is described. Patients received extradural pentazocine 30 mg or extradural buprenorphine 0.3 mg to provide postoperative analgesia. Interval for the next analgesia was significantly greater after extradural buprenorphine (18.96 hours) than after extradural pentazocine (8.39 hours) (p less than 0.001). No serious side-effects were reported.

Topics: Abdomen; Adult; Aged; Analgesia, Epidural; Buprenorphine; Female; Humans; Male; Middle Aged; Pain, Postoperative; Pentazocine; Time Factors

This randomized study examined the effect of transcutaneous electrical nerve stimulation (TENS) and indomethacin on postoperative opiate requirement in 60 patients after cholecystectomy. An open intravenous bolus of 25 mg of indomethacin followed by an infusion of 5 mg in 1 h, alone or combined with either low or high frequency TENS, was administered during the study period of 16 h. An intravenous bolus of either 5 mg of oxycodone or 0.15 mg of buprenorphine was administered double blindly for postoperative pain relief. The number of doses of buprenorphine given (3, 9) differed (P = 0.01) from the number of doses of oxycodone given (5, 4). Neither indomethacin nor TENS reduced the postoperative opiate requirement.

Topics: Buprenorphine; Cholecystectomy; Double-Blind Method; Female; Humans; Indomethacin; Infusions, Intravenous; Injections, Intravenous; Male; Middle Aged; Oxycodone; Pain Measurement; Pain, Postoperative; Time Factors; Transcutaneous Electric Nerve Stimulation

Using a portable 2 ml.hr-1 type infusor (Baxter Infusor), the effect of continuous epidural infusion for post-operative pain relief for 72 hours was studied in 32 patients after upper abdominal surgery. The patients were randomly allocated into four groups: Group 1 (n = 8) received continuous epidural infusion of 1% mepivacaine and buprenorphine 0.2 mg (48 ml.hr-1); group 2 (n = 8) 1% mepivacaine and buprenorphine 0.4 mg (48 ml.hr-1); Group 3 (n = 8) saline and buprenorphine 0.2 mg (48 ml.hr-1); Group 4 (n = 8) saline and buprenorphine 0.4 mg (48 ml.hr-1). The effect was evaluated at intervals of 12-hour until 72 hours postoperatively. Patients received supplemental buprenorphine intramuscularly as needed. In each period during the 12 to 72-hour after operation, the percentage of the patients who needed no supplemental buprenorphine was 62.5-100%, which is higher than during the 0 to 12-hour (25.0%). The percentage of the patients who showed no pain on coughing and changing in position in Group 1 and 2 was higher than in Group 3 and 4 in each period (P less than 0.05 12-24 and 36-72 hr). Continuous epidural infusion using Baxter Infusor with the combination of 1% mepivacaine and buprenorphine is effective for alleviating postoperative pain during the 12 to 72 hours after the operation, and for prevention of pulmonary complications.

Topics: Abdomen; Adult; Aged; Analgesia, Epidural; Buprenorphine; Female; Humans; Infusion Pumps; Male; Mepivacaine; Middle Aged; Pain, Postoperative

Efficacy of continuous intravenous infusion for postoperative analgesia was evaluated in 20 patients who had undergone abdominal surgery for 72 hours postoperatively. The patients were randomly allocated to two groups: one group received continuous intravenous infusion of buprenorphine at 0.2 mg.24 hr-1 using a non-electronic, portable infusor 0.5 ml.hr-1 type (Baxter), while the other received infusion of pethidine at 50 mg.hr-1. During the first 12 postoperative hours, the frequency of "Fair" rating which indicated need of supplemental analgetics was significantly higher than the later 12-hour period until 72 hours in both groups. However, although during the first 12 hours continuous intravenous infusion was inadequate to alleviate postoperative pain compared with other 12-hour period, no patient received supplemental analgesics more than 2 times. During the 24 to 72 postoperative hours, 70% of cases needed no supplemental analgesics to alleviate postoperative pain. Continuous intravenous infusion of 0.2 mg.hr-1 buprenorphine or 50 mg.hr-1 pethidine was inadequate for postoperative analgesia during immediately after the operation to 36 hours postoperatively, especially during the first 12-hour period. However, this infusion was effective during 36 to 72 postoperative hours. There was no significant difference between buprenorphine group and pethidine group.

Topics: Aged; Buprenorphine; Female; Humans; Infusions, Intravenous; Male; Meperidine; Middle Aged; Pain, Postoperative

A randomized single-blind, double-observer trial was performed to evaluate the efficacy of a new non-steroidal anti-inflammatory analgesic drug, ketorolac, in the treatment of post-orthopaedic surgery pain. Sixty patients with moderate to severe pain were studied; 30 patients were treated with ketorolac at a dose of 30 mg intramuscularly up to 4-times a day, whilst the other 30 patients received 0.3 mg buprenorphine intramuscularly up to 4-times a day. A significant reduction in the severity of the pain was recorded in both groups. Throughout the study, comparable efficacy was found between the two therapies although buprenorphine showed greater efficacy during the first 8 hours. Interestingly, the withdrawals due to adverse events were significantly less in the ketorolac group (p less than 0.001). This study, therefore, suggests that ketorolac may be a useful and more acceptable alternative to buprenorphine in the treatment of post-orthopaedic surgery pain.

Topics: Adolescent; Adult; Aged; Analgesics; Buprenorphine; Female; Humans; Injections, Intramuscular; Ketorolac; Male; Middle Aged; Orthopedics; Pain Measurement; Pain, Postoperative; Single-Blind Method; Tolmetin

Topics: Aged; Analgesics, Opioid; Buprenorphine; Double-Blind Method; Esophageal Neoplasms; Esophagus; Female; Hemodynamics; Humans; Injections, Intramuscular; Male; Middle Aged; Morphine; Pain, Postoperative; Pentazocine; Randomized Controlled Trials as Topic

Seventy-five patients scheduled for major abdominal operations were randomly divided into four groups, each with a different postoperative analgesic regime. Group I: buprenorphine 4 micrograms/kg was injected i.v. every 4 h. Groups II-IV: all patients were preoperatively supplied with a thoracic epidural catheter that, however, was not used during the operation. Group II: bupivacaine 0.15 ml/kg was injected epidurally every 2 h, the first dose being 0.5%, the top-ups 0.25%. Group III: buprenorphine 4 micrograms/kg in 10 ml saline was given via the catheter and repeated on request. Group IV: these patients received a combined regime. Bupivacaine was injected as in group II, and in addition buprenorphine was added epidurally in the doses and time intervals of group I. After extubation the patients categorized the intensity of postoperative pain twice, first while lying immobile and then after coughing vigorously, using a rating scale with pain scores from 0 to 10. Thereafter, the analgesic regime described above commenced. One hour later the patients' pain scores were again determined. In addition to pain scores, heart rate (HR), mean arterial pressure (MAP) and paCO2 were recorded at the same points in time. The investigation was then interrupted overnight. The analgesic regime continued as described for groups I and II. Patients in group III received 0.15 mg buprenorphine on request i.v., and in group IV bupivacaine was given as in group II with no further buprenorphine. The study recommenced the next morning at 7:00 a.m. After the initial values (pain scores, HR, MAP, paCO2) had been recorded the analgesic program, as scheduled for each patient, restarted. In group IV buprenorphine was again added to bupivacaine and repeated every 4 h, whereas bupivacaine was injected every 2 h. All values were registered hourly until 7:00 p.m., when the investigation was terminated. RESULTS. On the day of operation and during the first few hours on the morning thereafter, analgesia in groups II and IV was considerably better compared to groups I and III (P less than 0.001). We could not statistically demonstrate, however, that analgesia in group IV was superior to that in group II despite the fact that pain scores were lowest in this group, with a median at rest of 0 throughout the study time. In group III (n = 20), epidural buprenorphine failed to produce any acceptable analgesic effect in 6 patients despite correct catheter position. For this reason they were dropped

Topics: Abdomen; Analgesia, Epidural; Bupivacaine; Buprenorphine; Catheters, Indwelling; Female; Hemodynamics; Humans; Injections, Intravenous; Male; Middle Aged; Pain, Postoperative; Randomized Controlled Trials as Topic

This study was performed on fifty patients undergoing gynecological operations of lower abdomen. Their mean age and body weight were 43 +/- 5yrs and 55 +/- 8kg (mean +/- SD) respectively. All patients were given spinal anesthesia for surgery. Patients were divided into four groups of ten patients at random as follows: Group I (control) received 7.5mg of dibucaine only, Group II received 7.5mg of dibucaine with 0.05mg of buprenorphine (B), Group III received 7.5mg of dibucaine with 0.25mg of morphine (M), Group IV was the same as G-III but received 0.2mg of naloxone after operation. We observed EEG during operation and assessed intrathecal B and M for postoperative analgesic effect and side effects. EEG finding was as follows. In G-I, alpha and beta waves appeared dominantly during operation. In G-II, G-III and G-IV, EEG showed specific beta wave which is characterized with low voltage and rapid activity. This specific EEG change emerged at 10 minutes after the intrathecal injection of M in G-III and G-IV, and at 60 minutes after the intrathecal injection of B in G-II. This finding showed that intrathecal M with less lipid solubility reached more rapidly to CSF in the fourth ventricle than intrathecal B. The result suggests that the earlier respiratory depression may be caused by large doses of intrathecal M. Postoperative analgesic effect was recognized remarkably in G-II, G-III and G-IV (P less than 0.01). The duration for pain relief was 6 hrs in G-II and 12 hrs in G-III and G-IV.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Buprenorphine; Electroencephalography; Female; Humans; Injections, Spinal; Middle Aged; Morphine; Pain, Postoperative; Randomized Controlled Trials as Topic

A randomized trial comparing 2.5 and 5 micrograms/kilogram body weight of buprenorphine and 0.8 milligram/kilogram pethidine, intravenously for intraoperative use in a balanced anaesthetic technique, and for postoperative analgesia was carried out. Compared with pethidine, buprenorphine was shown to be a satisfactory analgesic for preoperative and postoperative use with little difference in the incidence of unwanted effects and much longer duration of action. Increasing the dose of buprenorphine did not give any significant advantage.

Topics: Adult; Analgesia; Anesthesia, General; Buprenorphine; Female; Humans; Intraoperative Period; Male; Meperidine; Pain, Postoperative

Buprenorphine and pethidine as postoperative analgesics were compared in 96 women having gynaecological operations by lower laparotomy. A fixed dose of the respective drug was given in a double-blind and double-dummy manner, initially intramuscularly and thereafter by sublingual buprenorphine (0.4 mg) or intramuscular pethidine (75 mg) at the request of the patient during the first 24 h postoperatively. Patients receiving buprenorphine had longer dose intervals and thus needed fewer doses. The analgesic effect, as assessed by a visual analog scale, was similar with both drugs. There were no significant differences between the groups regarding respiratory depression and nausea. It appears that sublingual buprenorphine is as effective and safe as intramuscular pethidine in the postoperative period.

Topics: Administration, Sublingual; Adolescent; Adult; Aged; Buprenorphine; Double-Blind Method; Female; Humans; Injections, Intramuscular; Laparotomy; Meperidine; Middle Aged; Pain Measurement; Pain, Postoperative; Placebos; Random Allocation; Time Factors

This study aimed to compare the efficacy and side-effects of sublingual buprenorphine, a synthetic opioid agonist antagonist, with those of subcutaneous morphine. Fifty ASA class 1 patients were included in the study after having given their informed consent. Caesarean section was carried out under epidural block with 0.5% bupivacaine; no opioids were used during the procedure. The first dose of opioid was given 2 h after the first dose of bupivacaine. Patients were randomly given either 10 mg morphine (n = 25) or 0.4 mg buprenorphine (n = 25), followed by the same dose every 6 h for 36 h. When analgesia was insufficient, tablets containing dextropropoxyphene and paracetamol were given. No attempt was made to blind the study to the patient, but the investigator assessing pain was unaware of the drug given to the patient. Pain intensity was assessed before, and 2 h after each dose of opioid with a 100 mm visual scale, as well as systolic, diastolic and mean arterial blood pressures, heart and breathing rates, and SpO2. Side-effects (pruritus, nausea, vomiting, drowsiness) were also noted. In 2 patients in each group, the protocol was stopped before the 36th h, but after the fourth dose, either because of side-effects, or at the patient's request. Results were similar in both groups of patients, whether for degree of pain relief, or physiological effects. There was no clinically detectable respiratory depression. Duration and intensity of episodes of arterial oxygen desaturation, and the incidence of nausea, were similar in the 2 groups; pruritus was more common in the morphine group.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Buccal; Adult; Blood Pressure; Buprenorphine; Cesarean Section; Female; Heart Rate; Humans; Injections, Subcutaneous; Morphine; Nausea; Oxygen; Pain, Postoperative; Pregnancy; Pruritus

Topics: Analgesia; Anesthesia, General; Buprenorphine; Double-Blind Method; Humans; Injections, Spinal; Morphine; Pain, Postoperative; Thoracotomy; Urinary Retention

Epidural morphine is associated with a high incidence of pruritus when used for pain control in the post-Caesarean section population. The purpose of this study was to compare the incidence of pruritus associated with epidural morphine, fentanyl, buprenorphine and butorphanol. Sixty healthy Caesarean section patients were studied in a double-blind randomized fashion. Patients were questioned at 1, 3, 12 and 24 hours postpartum for the incidence of pruritus. This study demonstrated that the incidence of pruritus was significantly higher following the use of epidural morphine and fentanyl. Even though epidural butorphanol and buprenorphine exhibited a low incidence of pruritus, their duration of analgesia was not long enough to make either attractive for single-dose administration.

Topics: Adult; Analgesia, Epidural; Analgesics, Opioid; Buprenorphine; Butorphanol; Cesarean Section; Clinical Trials as Topic; Double-Blind Method; Female; Fentanyl; Humans; Morphine; Pain, Postoperative; Pregnancy; Pruritus; Random Allocation

The authors have compared two different techniques of anaesthesia: the classical anaesthesia with benzodiazepine-analgesic (diazepam and fentanyl) and one of its variant obtained by using flunitrazepam and buprenorphine. The 45 patients submitted to gynaecological surgery were causally divided in two groups in connection with the two different anaesthesiological techniques. The clinical and statistical analysis of the collected data demonstrated the real validity of this anaesthesiological variant: either for premedication by perfect anxiolysis and sedation, or for the maintenance by low incidence on cardiocirculation system and perfect analgesia that extended its effects for many hours after surgical operation.

Topics: Adult; Aged; Blood Pressure; Buprenorphine; Clinical Trials as Topic; Diazepam; Female; Fentanyl; Flunitrazepam; Gynecology; Humans; Middle Aged; Pain, Postoperative; Preanesthetic Medication; Random Allocation

Two doses of intrathecal buprenorphine for postoperative analgesia have been compared. Forty-five women undergoing elective caesarean section under spinal anaesthesia were randomly divided into three groups. Group A (controls, n = 15) received hyperbaric bupivacaine; Groups B and C received the same but with the addition of 0.03 mg or 0.045 mg buprenorphine, respectively. Patients receiving buprenorphine had a longer pain-free interval than the controls (P less than 0.01). Within the buprenorphine groups, patients receiving the higher dose had a longer effect (420 min s.d. 24) than those receiving the lower dose (173 min s.d. 31) (P less than 0.01) without any increase in side-effects.

Topics: Adult; Analgesia, Epidural; Anesthesia, Obstetrical; Anesthesia, Spinal; Buprenorphine; Cesarean Section; Double-Blind Method; Female; Humans; Injections, Spinal; Pain, Postoperative; Pregnancy; Random Allocation

Topics: Adult; Analgesics, Opioid; Anesthesia, Conduction; Anesthesia, General; Buprenorphine; Endorphins; Female; Humans; Hydrocortisone; Lipoproteins, LDL; Morphine; Pain, Postoperative; Stress, Psychological

Topics: Adult; Anesthetics, Local; Buprenorphine; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Middle Aged; Pain Measurement; Pain, Postoperative; Random Allocation

A double-blind study was carried out to assess the efficiency and possible side-effects of a single epidural injection of either morphine or buprenorphine at equipotent doses after elective thoracic surgery. The series included 24 patients aged 53.7 +/- 11.4 years; 13 underwent a lobectomy and 11 a pneumonectomy. 6 h after the last intravenous injection of fentanyl, the patients were randomly allocated to one of three equal groups. They received an epidural injection at T8-9 or T9-10 level of either 100 micrograms.kg-1 morphine (group M) or 6.6 micrograms.kg-1 buprenorphine (group B) or a subcutaneous injection of 0.1 ml.kg-1 normal saline placebo at the same level (group T). The following parameters were measured 20 and 60 min, and every 6 h up to 48 h after the injection: patient wakefulness, respiratory rate, blood gases, pain (according to a verbal scale), FVC and FEV1, adverse effects (euphoria, hallucinations, sweating, facial pruritus, nausea) and atelectasis. The duration of surgery, the anaesthetic protocol, the age, weight and height, as well as all the parameters before injection were similar in all three groups. There was a fall in pain intensity from the 20th min to the 24th hour in group M and from the 20th min to the 36th hour in group B, significant for both groups when compared with group T. Similarly, there was a prolonged increase in FEV1 in both groups M and B. There was no case of severe respiratory depression; PaCO2 was increased at the 1st hour (+0.3 +/- 0.6 kPa) in group B and at the 6th hour (+0.5 +/- 0.7 kPa) in group M.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Analgesia, Epidural; Blood Gas Analysis; Buprenorphine; Double-Blind Method; Humans; Lung Volume Measurements; Middle Aged; Morphine; Pain, Postoperative; Postoperative Complications; Pulmonary Atelectasis; Respiration; Thoracic Surgery

Perioperative effects of buprenorphine during and after combined anesthesia for gynecological laparotomies were compared to those of morphine. In a controlled, randomized study two similar groups of patients received flunitrazepam (0.016 mg/kg) and either buprenorphine (0.008 mg/kg) or morphine (0.333 mg/kg); all patients were ventilated with a N2O/O2-mixture. To maintain adequate anesthesia, additional injections of buprenorphine or morphine and a volatile anesthetic agent (enflurane, less than 1.0 vol.%) were administered as needed. In some patients in both groups the injection of thiopental (1-2 mg/kg) became necessary for induction of anesthesia. Hemodynamic parameters showed a slight but not significant increase during intubation and remained stable intraoperatively (Figs. 1 and 2). The frequencies of additional intraoperative injections of buprenorphine or morphine and modalities of enflurane administration were similar in both groups. Based on an awakeness score, recovery from anesthesia was similar in both groups (Fig. 3). All patients were pain-free for a long period postoperatively (pain score 1-2, duration 6-10 h) (Fig. 4). In both groups respiratory depression could be demonstrated by means of ventilatory CO2 response (Figs. 6 and 7). The respiratory depression was of no clinical importance and seems to have been due to the combination of a long-acting benzodiazepine with an opiate. There were no differences in the occurrence of nausea and vomiting in both groups. Buprenorphine seems to be an alternative to morphine in combined anesthesia.

Topics: Acid-Base Equilibrium; Adult; Anesthesia, Endotracheal; Anesthesia, General; Anesthesia, Intravenous; Buprenorphine; Clinical Trials as Topic; Female; Genital Diseases, Female; Hemodynamics; Humans; Morphine; Pain, Postoperative; Random Allocation

We report a prospective double-blind trial of the efficacy of a single epidural dose of buprenorphine on pain after spinal decompression. Postoperative pain was assessed by a linear analogue pain chart and by the additional requirement for analgesia. The patients receiving buprenorphine were significantly more comfortable (p less than 0.005) and required less analgesia in the first 12 hours after operation (p less than 0.05) than the control group. This simple procedure is recommended as an effective and safe method of reducing pain.

Topics: Adolescent; Adult; Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Injections, Epidural; Male; Middle Aged; Opium; Pain, Postoperative; Prospective Studies; Spine

In a randomized double-blind study of 57 children (aged 6 months-6 yr), pain following lateral thoracotomy was relieved with repeated i.v. doses of morphine 100 or 50 micrograms kg-1, or buprenorphine 3.0 or 1.5 micrograms kg-1. The same drug and dosage were continued and cardioventilatory indices, pain intensity and sedation measured for an observation period of 24 h. The sums of the pain intensity differences were equal in all groups. The mean doses for the complete initial analgesia were 230 and 180 micrograms kg-1 with the larger and the smaller bolus doses of morphine and 5.8 and 3.7 micrograms kg-1 with buprenorphine, respectively. The mean duration of action of buprenorphine was slightly but not significantly longer than that of morphine. The total consumption of both morphine and buprenorphine was less when the smaller bolus doses were used. Two patients developed a degree of ventilatory depression following repeated doses of buprenorphine. Buprenorphine was equal to morphine as a postoperative analgesic.

Topics: Buprenorphine; Child; Child, Preschool; Depression, Chemical; Double-Blind Method; Humans; Infant; Morphine; Pain Measurement; Pain, Postoperative; Respiration; Thoracotomy

The safety and efficacy of buprenorphine and morphine as postoperative analgesics for children were compared in 60 boys and girls 4 to 14 years old having elective orthopedic operations on upper or lower extremities. The drugs were given in a double-blind manner initially intravenously and thereafter by sublingual buprenorphine or intramuscular morphine administered as required to relieve pain until the third postoperative morning. The IV dose needed to achieve complete initial analgesia was 5.2 +/- 2.8 micrograms/kg buprenorphine and 166 +/- 100 micrograms/kg morphine. The duration of effect was significantly longer with buprenorphine than with morphine, 248 +/- 314 and 114 +/- 109 minutes, respectively (P = 0.03). The most common side effects were nausea and vomiting (28 and 16%) and urinary retention (21 and 19%) in the buprenorphine and morphine groups, respectively. Analgesia with sublingual buprenorphine was as effective and reliable as with intramuscular morphine but a longer duration of action could not be demonstrated.

Topics: Administration, Sublingual; Adolescent; Buprenorphine; Child; Child, Preschool; Double-Blind Method; Female; Humans; Injections, Intramuscular; Male; Morphine; Pain, Postoperative; Random Allocation

Ninety patients aged 56-85 years scheduled for suprapubic prostatectomy, randomly received intrathecally either bupivacaine 30 mg (group A, n = 30), bupivacaine 30 mg plus buprenorphine 0.03 mg (group B, n = 30) or bupivacaine 30 mg plus buprenorphine 0.045 mg (group C, n = 30). Prolonged postoperative analgesia, minimal disturbance of consciousness and comfortable breathing were common to the groups that received buprenorphine. The higher concentration of buprenorphine improved the quality and duration of analgesia. The only side effects found in the buprenorphine groups were nausea and vomiting in 11 and 14 patients, respectively, in groups B and C. Our study shows that buprenorphine is an effective analgesic, suitable for the management of postoperative pain in elderly patients.

Topics: Aged; Aged, 80 and over; Anesthesia, Spinal; Bupivacaine; Buprenorphine; Double-Blind Method; Humans; Injections, Spinal; Male; Middle Aged; Pain, Postoperative; Prostatectomy; Respiration; Time Factors

Fifty-seven women received extradural morphine 3 mg, buprenorphine 0.18 mg or buprenorphine 0.09 mg after elective Caesarean section carried out under extradural bupivacaine. Supplementary sublingual buprenorphine was available on demand. Ten-centimetre visual analogue pain scores were completed regularly; emesis, pruritus and urinary retention were recorded for 24 h. Patients who received buprenorphine 0.09 mg had more pain, and required more supplementary analgesia, than those who received morphine 3 mg. Pain scores and analgesic requirements after buprenorphine 0.18 mg were not significantly different from either of the other two groups. Emesis was not significantly different in the three groups. More itching occurred after morphine 3 mg and buprenorphine 0.18 mg than after buprenorphine 0.09 mg; pruritus of the face, legs and perineum was more common after morphine than buprenorphine. Twenty-eight percent of patients without a urinary catheter developed retention of urine. Seventy-five to 84% of patients were satisfied with analgesia during the first day after operation. Analgesia and adverse effects were similar when morphine 3 mg or buprenorphine 0.18 mg was given extradurally after Caesarean section.

Topics: Buprenorphine; Cesarean Section; Female; Humans; Injections, Epidural; Morphine; Pain, Postoperative; Pregnancy

Eighty patients recovering from major operations were investigated to evaluate the influence of naloxone on the analgesic and respiratory depressant properties of buprenorphine. They were randomly assigned to two groups to self-administer either buprenorphine (Group B) or a mixture of buprenorphine and naloxone (fraction 60%; Group BN) in the early postoperative period by means of the On-Demand Analgesia Computer (ODAC). The duration of patient-controlled analgesia (PCA) was 21.0 h (B) or 23.5 h (BN), during which 12.2 (B) and 18.2 (BN) demands per patient were recorded, representing significantly different consumption of buprenorphine 0.80 (B) and 1.07 (BN) microgram.kg-1.h-1. Retrospective pain scores were significantly better in Group B, and respiratory rate was significantly higher in Group BN. The analgesia was judged superior by 81% (B) and 88% (BN) of the patients compared to conventional postoperative pain treatment. The minimum effective buprenorphine concentration (MEC) varied greatly in both groups with no significant differences between them (median 0.4 ng.ml-1, range 0.1-8.6 ng.ml-1); intra-individual variability was lower (67.9% B, and 58.2% BN) than inter-individual variability (107.3% B and 84.0% BN). Accumulation in plasma and acute tolerance did not occur. Thus, admixture of 60% naloxone decreased both the analgesic and respiratory depressant effects of buprenorphine which were generally independent of plasma concentrations. The analgesia achieved with the buprenorphine/naloxone mixture under patient-controlled conditions was comparable to that of other narcotic analgesics. Accordingly, this drug combination may be expected to give clinically adequate analgesia without notable impairement of spontaneous respiration, whilst withdrawal symptoms would probably arise in drug addicts abusing other opiates.

Topics: Blood Pressure; Buprenorphine; Drug Interactions; Heart Rate; Humans; Male; Naloxone; Pain, Postoperative; Respiration

Actively involving the patient in his or her own pain management by using patient-controlled analgesia (PCA) during the postoperative period is a concept recently introduced. This method allows self-administration of small, frequent doses of an analgesic agent to maintain a state of constant pain control. We studied the relative efficacy of PCA compared with intermittent analgesic dosing in 16 male patients requiring posterolateral thoracotomy. Eight patients received intermittent doses of buprenorphine hydrochloride (0.3 mg intramuscularly every 3 to 6 hours), and eight patients were allowed to self-activate a PCA device according to a designed protocol. In the patients using PCA, a significant reduction in the postoperative pulmonary complication rate, as evidenced by radiographic findings, was noted. In addition, significantly less medication was used and postoperative fever was substantially reduced in the PCA group. We believe PCA to be a safe, effective, and beneficial pain management modality that deserves attention in the postoperative period.

Topics: Aged; Analgesia; Buprenorphine; Drug Administration Schedule; Humans; Injections, Intramuscular; Male; Middle Aged; Pain, Postoperative; Prospective Studies; Random Allocation; Self Administration; Thoracotomy

Epidural sufentanil 50 micrograms was compared with intramuscular buprenorphine 0.3 mg for postoperative pain relief. Patients were assigned randomly to one of two treatment groups and received both an intramuscular and epidural injection, one of which was a placebo. Onset of pain relief was faster and quality of analgesia superior during the first 2 hours in the patients who received epidural sufentanil but the duration of analgesia was longer in the buprenorphine group. Cardiovascular variables remained stable in all patients and no respiratory depression was observed. Side effects were more frequent following buprenorphine.

Topics: Adult; Analgesics, Opioid; Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Female; Fentanyl; Humans; Injections, Epidural; Injections, Intramuscular; Male; Pain, Postoperative; Sufentanil; Time Factors

In a randomized, double-blind study, buprenorphine was compared with morphine in the treatment of pain after major abdominal operations by means of continuous-plus-on-demand epidural infusion for constant analgesia. The patients received bolus epidural injections of 0.15 mg buprenorphine or 2 mg morphine-HCl prior to an on-demand epidural infusion of 0.03% buprenorphine or 0.25% morphine HCl at a basal rate of 0.06 ml/h. Over 50 h, mean buprenorphine consumption was 0.85 +/- 0.08 mg, and mean morphine consumption was 6.4 +/- 0.5 mg. Under the treatment, no discomfort or side-effects necessitating treatment occurred. We conclude that buprenorphine is a useful substitute for morphine in the treatment of pain after major abdominal operations by continuous-plus-on-demand epidural infusion, and that the relative analgesic potency ratio of epidural buprenorphine is 8.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Epidural Space; Female; Humans; Injections; Male; Middle Aged; Morphine; Pain, Postoperative; Random Allocation

Topics: Adolescent; Adult; Buprenorphine; Child; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Meperidine; Middle Aged; Pain, Postoperative; Random Allocation

The analgesic efficacy, side effects and cost of administration of regimens of intravenous buprenorphine and intravenous morphine were compared in a randomized double-blind trial performed during the first 24 h after cardiac surgery. Seven patients received buprenorphine by intermittent intravenous injection and six received morphine by continuous infusion. Both these regimens provided good analgesia for the entire 24 h period, with only mild pain at rest and moderate pain on vigorous coughing. Both regimens also produced mild respiratory depression but this was not of clinical importance: the mean arterial PCO2 in both groups was less than 45 mmHg after extubation. The major difference between drugs in the clinical setting was the ease of administration. Buprenorphine had no narcotic code restriction and could be given by intermittent intravenous injection, whereas morphine required checking and handling as a restricted drug and administration by continuous intravenous infusion. When labour and material costs were computed, over the first 24 postoperative hours, it cost $19.76 per patient to administer morphine, but only $3.16 to administer buprenorphine. Thus the use of buprenorphine injections for the first 24 h after cardiac surgery produced pain relief and respiratory depression comparable to that produced by a morphine infusion, but with a significant cost saving in terms of labour and materials.

Topics: Buprenorphine; Clinical Trials as Topic; Coronary Artery Bypass; Costs and Cost Analysis; Double-Blind Method; Humans; Infusions, Intravenous; Morphine; Pain Measurement; Pain, Postoperative; Prospective Studies; Random Allocation; Respiration

A double-blind, sex-stratified, study compared the analgesic efficacy and side effects of nalbuphine 10 mg ml-1 (group N) and buprenorphine 0.15 mg ml-1 (group B) administered as a continuous infusion (0.2 ml kg-1/24 h), after abdominal surgery. Patients could request additional i.m. analgesic for pain. The study groups were well matched. The trial was stopped after 55 patients had been studied (nalbuphine 29, buprenorphine 26), because nine patients in the nalbuphine group had inadequate pain relief (P less than 0.01) shortly after surgery (mean 2.5 h). Analysis of the results on an "intention to treat" basis showed that the patients who received buprenorphine had significantly greater pain relief at 1, 3, 6 and 20 h after surgery. Patients who received buprenorphine were assessed by the physiotherapist to have less pain and better chest expansion. More additional analgesic was given to the patients receiving nalbuphine. In the patients receiving buprenorphine, the mean ventilatory rate was less (N = 19 b.p.m., B = 14 b.p.m.) (P less than 0.001) and the increase in PaCO2 was greater (N = 0.5 kPa, B = 1.1 kPa) (P less than 0.001), compared with the value before operation. Side effects were equal, and no serious adverse effects were observed in either group.

Topics: Abdomen; Adolescent; Adult; Aged; Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Morphinans; Nalbuphine; Pain, Postoperative; Physical Therapy Modalities; Respiration

Sixty patients undergoing gynaecological laparotomies under isoflurane anaesthesia received 0.4 mg of buprenorphine sublingually or 0.12 mg/kg of oxycodone intramuscularly in random order for preanaesthetic medication. Patients premedicated with buprenorphine were given buprenorphine before, during and after anaesthesia and patients premedicated with oxycodone received fentanyl before and during anaesthesia and oxycodone after anaesthesia. Buprenorphine premedication produced less drowsiness and sedation and alleviated patients' apprehension significantly (P less than 0.05) less than oxycodone. Systolic and diastolic blood pressure and heart rate were significantly (P less than 0.05 to P less than 0.01) higher after intubation in the buprenorphine group when compared with the oxycodone plus fentanyl group. After anaesthesia, spontaneous respiration started rapidly; the return of consciousness and immediate recovery occurred at the same rate in both groups. In the recovery room moderate to severe pain was more common (P less than 0.05) in the oxycodone plus fentanyl group than in the buprenorphine group. The respiratory rate in the recovery room was lower among patients given buprenorphine, and two patients given buprenorphine developed severe respiratory depression. In the ward (2 to 24 h after operation) sublingual buprenorphine provided pain relief as good as intramuscularly administered oxycodone. No differences were noted in the incidence or severity of emetic symptoms between the groups. It is concluded that buprenorphine can provide good postoperative pain relief for gynaecological laparotomies performed under light isoflurane anaesthesia, but patients need to be monitored carefully after operation because of the possibility of respiratory depression.

Topics: Adult; Analgesia; Anesthesia, Endotracheal; Anesthesia, General; Buprenorphine; Clinical Trials as Topic; Codeine; Female; Fentanyl; Heart Rate; Humans; Injections, Intravenous; Isoflurane; Nitrous Oxide; Oxycodone; Pain, Postoperative; Premedication; Random Allocation; Respiration

Topics: Administration, Sublingual; Adult; Buprenorphine; Female; Humans; Injections, Intramuscular; Male; Meperidine; Pain, Postoperative

Topics: Abdomen; Administration, Sublingual; Adult; Buprenorphine; Female; Humans; Injections, Intramuscular; Injections, Intravenous; Male; Meperidine; Middle Aged; Morphine; Pain, Postoperative

In a double-blind randomized study of three groups of 18 patients scheduled for major abdominal surgery the efficacy and side effects of sublingual buprenorphine were tested and compared to intramuscular meperidine and buprenorphine. Single doses of either 75 mg of meperidine, 0.4 mg of sublingual buprenorphine, or 0.3 mg of intramuscular buprenorphine were used. Patients given buprenorphine as sublingual tablets were significantly more conscious in the immediate postoperative period (Glasgow Coma Scale) than when given buprenorphine or meperidine intramuscularly. Median pain intensity differences (PID) showed equal pain relief, whereas the summarized pain intensity differences (SPID) were significantly higher in the intramuscular buprenorphine group compared to the meperidine group. Three cases of respiratory acidosis in the meperidine group required IPPV treatment, and one case in the intramuscular buprenorphine group required treatment. Sedation and nausea were the most common side effects in all three groups. We conclude that sublingual buprenorphine is useful for relief of postoperative pain and exhibited administrative advantages, when the patients were able to cooperate.

Topics: Abdomen; Acidosis, Respiratory; Adolescent; Adult; Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Humans; Injections, Intramuscular; Meperidine; Middle Aged; Pain, Postoperative

Topics: Administration, Sublingual; Buprenorphine; Double-Blind Method; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Pain, Postoperative; Random Allocation

Fifty-two patients undergoing biliary surgery were investigated in a prospective randomized study, in which they received buprenorphine 10, 20, 30, and 40 micrograms X kg-1, respectively, as sole intravenous analgesic as a bolus 15 min before induction of anaesthesia. The anaesthetic was uneventful in all four groups, although when receiving 10 and 20 micrograms X kg-1 almost two-thirds of the patients needed supplemental analgesics during the operation. When receiving buprenorphine in the dosage of 30 and 40 micrograms X kg-1, 50% of the patients requested an analgesic within 5 min of extubation. In contrast, when receiving 10 and 20 micrograms X kg-1 none of the patients requested an analgesic within 1 h of the operation. These findings accord to a certain extent with the presence of a bell-shaped dose-response curve for buprenorphine in humans.

Topics: Biliary Tract Surgical Procedures; Buprenorphine; Female; Humans; Intraoperative Period; Male; Pain, Postoperative; Respiration

The analgesic potency, efficacy, duration of action and side-effects of buprenorphine (Temgesic) 0.3 mg and 0.6 mg were compared with those of pentazocine (Sosegon) 30 mg and 60 mg in 100 male patients who had undergone orthopaedic surgical procedures. The drugs were given by intramuscular injection 30 minutes before completion of the surgical procedure, and the quality of pain relief and incidence of side-effects were assessed at 30-minute intervals for at least 6 hours. Buprenorphine was shown to be safe, to be more potent and to have a longer duration of action than pentazocine, and to result in less nausea, vomiting and euphoria, but it was associated with a higher incidence of postoperative sedation than pentazocine.

Topics: Adolescent; Adult; Buprenorphine; Clinical Trials as Topic; Humans; Male; Morphinans; Pain, Postoperative; Pentazocine; Random Allocation; Time Factors

In a double-blind controlled study, epidural buprenorphine 0.3 mg was compared with 4 mg of epidural morphine for postoperative pain relief the first 24 hours after major orthopaedic surgery. The degree of analgesia was equal and satisfactory in both groups. Duration of action was 620 minutes with buprenorphine and 580 minutes with morphine, which was not significantly different. The only serious side effects were recorded in the morphine group, with two patients complaining of pruritus and five of urinary retention. In conclusion, epidural buprenorphine did not offer any advantages in preference to morphine for postoperative pain relief following orthopaedic surgery.

Topics: Adolescent; Adult; Aged; Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Drug Evaluation; Epidural Space; Female; Humans; Injections; Male; Middle Aged; Morphinans; Morphine; Pain, Postoperative

Topics: Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Humans; Morphinans; Pain; Pain, Postoperative

Forty-five patients scheduled for major abdominal or intrathoracic surgery were assigned at random to two different groups. One group received 0.3 mg and the other 0.9 mg of buprenorphine epidurally to abolish postoperative pain. The first dose was given immediately upon arrival in the ICU, irrespective of pain. Subsequent medication was given on demand. The duration of action and side-effects were recorded. Both doses produced excellent and long-lasting pain relief, but no statistically significant difference was found between the groups, with regard to either the duration of action or the occurrence of side-effects.

Topics: Adult; Aged; Anesthesia; Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Epidural Space; Female; Humans; Injections; Male; Middle Aged; Pain, Postoperative; Random Allocation

A randomized, double-blind, placebo-controlled study of buprenorphine was carried out in 20 patients after cholecystectomy. The drug was given on "patient demand" either i.m. (0.15 mg) or sublingually (0.2 mg) with a minimum dose interval of 30 min. Over the 24-h study period the mean demand by the sublingual route was 0.8 mg (range 0.6-1.2 mg) and by the i.m. route 0.66 mg (range 0.45-0.9 mg). Pain relief, by visual analogue scales and grading, was similar. Plasma buprenorphine concentrations varied more after sublingual administration. Either route was effective for the treatment of pain when administered by "patient demand".

Topics: Administration, Oral; Adolescent; Adult; Aged; Buprenorphine; Cholecystectomy; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Morphinans; Pain, Postoperative; Tongue

Eighty otherwise healthy women, aged 22-64 years, admitted for elective hysterectomy were studied in a prospective randomized trial. The aim was to compare two different postoperative pain relief schedules--one with the analgesic given at regular intervals and the other with the analgesic given on demand. All the patients had a neuroleptanaesthesia with fentanyl. Forty patients received an initial dose of buprenorphine 0.3 mg intravenously before termination of anaesthesia and continued with sublingual buprenorphine 0.4 mg 6 hourly postoperatively (regular interval (RI) group). Forty patients received the standard postoperative medication, meperidine 1 mg/kg on demand in the recovery room, followed by ketobemidone 5 mg subcutaneously on demand in the surgical ward (on demand (OD) group). There was no difference between groups concerning pain relief following a single dose of analgesic (P greater than 0.05, type II error 1-5%). In the recovery room 17.5% of the patients in the RI group received an analgesic compared to 87.5% in the OD group (P less than 0.05). Among patients in the RI group who had previously got injections for postoperative pain relief on demand 95% preferred regular interval sublingual buprenorphine for future treatment. The nurses found that 90% of the patients in the RI group were treated adequately compared to 62.5% of the patients in the OD group (P less than 0.05). It is concluded, that regular interval preventive pain relief is superior to conventional on demand analgesic therapy in postoperative pain.

Topics: Adult; Analgesics, Opioid; Buprenorphine; Clinical Trials as Topic; Drug Administration Schedule; Female; Humans; Hysterectomy; Meperidine; Middle Aged; Morphinans; Pain, Postoperative

Sixty postoperative orthopaedic patients were randomly assigned to three equal groups to study, in a double-blind fashion, the analgesic effects, durations of action and side effects of the extradural administration of lofentanil 5 micrograms, buprenorphine 0.3 mg or physiological saline. No systemic analgesics were given before, during or after surgery, and all the patients had operations on the lower extremities under extradural analgesia (lignocaine and bupivacaine). Eleven millilitre of the test drug was injected at T12-L1 as soon as pain occurred in the postoperative period. We observed a long duration of action and a marked analgesic effect with lofentanil, a shorter duration of action and less pain suppression with buprenorphine and a rather marked placebo effect after saline. The only side effect noticed in this study was drowsiness in three patients in the lofentanil group and in two patients in the buprenorphine group.

Topics: Adult; Aged; Analgesics, Opioid; Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Epidural Space; Female; Fentanyl; Humans; Injections; Male; Middle Aged; Morphinans; Pain, Postoperative

Topics: Administration, Oral; Adult; Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Humans; Injections, Intramuscular; Meperidine; Morphinans; Mouth Floor; Pain, Postoperative

Fifty-one patients undergoing cholecystectomy received a single dose of buprenorphine 4.5-12 micrograms kg-1 at induction. Median duration of analgesia after surgery was 6 h. Multiple regression analysis showed the duration of analgesia to be slightly dependent on the age of the patient. No relationship was found between the duration of analgesia and the weight-related dose of buprenorphine, the age, sex or body weight of the patient, the duration of anaesthesia, or the dose of droperidol or thiopentone administered.

Topics: Adjuvants, Anesthesia; Adult; Aged; Anesthesia, General; Buprenorphine; Cholecystectomy; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Morphinans; Pain, Postoperative; Regression Analysis; Time Factors

Topics: Adult; Aged; Anesthesia, Epidural; Buprenorphine; Cholecystectomy; Clinical Trials as Topic; Humans; Middle Aged; Morphinans; Morphine; Pain, Postoperative; Vagotomy

Epidural buprenorphine was investigated as a postoperative analgesic in a randomized double-blind study of 158 patients given epidural analgesia with mepivacaine or bupivacaine for orthopedic surgery of the lower extremity. At the end of surgery, patients were given either 0.15 mg of epidural buprenorphine (n = 38), 0.3 mg (n = 37) in 15-ml saline, or no further epidural injections (n = 47, control group) after 2% mepivacaine for intraoperative anesthesia. A fourth group (n = 36) received 0.3 mg of buprenorphine in 15-ml saline, after the intraoperative use of 0.5% bupivacaine. The patients rated postoperative pain. The need for additional analgesics as well as side effects were recorded. Analgesia after 0.15 mg buprenorphine was superior to that after no reinjection for 6 hr after surgery (P less than 0.05). Buprenorphine (0.3 mg) was superior both to no reinjection and to 0.15 mg of buprenorphine until the twelfth hour (P less than 0.05). Analgesia after bupivacaine followed by 0.3 mg of buprenorphine was not significantly different than analgesia seen after mepivacaine followed by 0.3 mg of buprenorphine. There was an increase of PaCO2 of 2-5 mm Hg between 1.5-3.5 hr after 0.3 mg of buprenorphine without any evidence for late respiratory depression. Other side effects, e.g., disturbances of micturition, pruritus, nausea, vomiting, fatigue, and headache, were comparably common in all groups. The epidural administration of 0.3 mg buprenorphine may be recommended for postoperative analgesia following orthopedic surgery of the lower extremity.

Topics: Adult; Anesthesia, Epidural; Buprenorphine; Clinical Trials as Topic; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Leg; Male; Mepivacaine; Middle Aged; Morphinans; Pain, Postoperative; Random Allocation

Topics: Adult; Aged; Buprenorphine; Clinical Trials as Topic; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Morphinans; Pain, Postoperative

Topics: Anesthesia, Epidural; Anesthesia, Intravenous; Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Morphinans; Pain, Postoperative

Eighty fit adults having elective abdominal hysterectomy or cholecystectomy received buprenorphine or morphine intravenously at the start of peritoneal closure, in a randomised double-blind trial. The anaesthetic sequence precluded the use of other narcotic analgesics. Pain scores were lower in patients who received buprenorphine, as were the cumulative numbers of patients withdrawn from the trial at each interval because of pain, statistical significance being achieved at all intervals from one to seven hours after administration. Unexpectedly, patients having the upper abdominal procedure were more likely to receive satisfactory analgesia than those having abdominal hysterectomy. Vomiting occurred more commonly after buprenorphine, and mean respiratory rates were slightly lower. However, the differences were not statistically significant. One patient with protracted drowsiness and slow respiratory rate after buprenorphine received naloxone. No serious side-effects were noted. Buprenorphine 4-6 micrograms/kg provided adequate postoperative analgesia of greater duration than could be achieved with morphine, and the potency of buprenorphine when administered in this way was at least 33 times that of morphine.

Topics: Adolescent; Adult; Aged; Buprenorphine; Cholecystectomy; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Hysterectomy; Male; Middle Aged; Morphinans; Morphine; Pain, Postoperative; Random Allocation; Respiration; Time Factors

In a prospective study, patients undergoing abdominal surgery were allocated randomly to receive intermittent morphine 10 mg i.m. (n = 41) or a single injection of buprenorphine 0.3 mg i.m. followed by sublingual buprenorphine 0.4 mg every 6 h (n = 39) for 3 days following operation. Patients receiving buprenorphine were allowed additional morphine, if required. Pain scores (linear analogue scale) in those patients receiving regular sublingual buprenorphine were consistently less than in those receiving intermittent morphine i.m. Half the patients receiving buprenorphine required no additional analgesia; only 15% required additional analgesia after the first day following operation. Arterial blood-gas analyses showed significant hypoxaemia and significantly greater carbon dioxide tensions in those receiving buprenorphine. These results suggest that a regimen based on the use of sublingual buprenorphine provides pain relief comparable to that provided by intermittent opiates i.m.

Topics: Abdomen; Administration, Oral; Buprenorphine; Carbon Dioxide; Female; Humans; Male; Middle Aged; Morphinans; Morphine; Oxygen; Pain, Postoperative; Prospective Studies; Random Allocation; Tongue

40 Patients undergoing elective orthopaedic surgery of the lower limb randomly received either Buprenorphin sublingual (0,4 mg.) (Bsl) or Pentazocin i.m. (30 mg.) (Pim) for postoperative pain therapy. They were neither premedicated nor sedated. Analgesia was measured with a Visual Analogue Scale (VAS) and assessments by the anaesthetist and patient. Physiological measures were: Blood pressure, heart rate, arterial blood gases and serum cortisol. Side effects were registered. After Pim well known data were obtained: onset (10-30 min.) and duration (2 hours) of action and a significant pain reduction 20, 30 and 60 minutes after injection, whereas with Bsl onset was 60-120 min. and duration 6-7 hours of action and significant pain reduction was seen 120 and 180 min. after administration. 8 dropouts after Bsl up to 120 min. post applications are interpreted as a result of late onset or lack of analgesic action whereas the 13 drop outs 3 hours after Pim can be explained with the short lasting analgesic action of Pentazocin. Serum cortisol levels were better after Bsl, but did not correlate with the VAS. In Blood gas analyses, there were no group differences, especially no hypoxic or hypercapnic periods. There were no severe cardiocirculatory side effects, but significantly more hypertonic reactions and tachycardia after Pim. Other side effects were rare in both groups. The methods are discussed. Bsl has late onset but long duration of action with a higher efficacy than Pim. Bsl is strong and long acting. After an initial intravenous injection Bsl (0,4 mg.) should be administered at 6-hourly intervals.

Topics: Administration, Oral; Adolescent; Adult; Aged; Blood Pressure; Buprenorphine; Heart Rate; Humans; Hydrocortisone; Leg; Middle Aged; Morphinans; Pain, Postoperative; Pentazocine

Sixty-nine patients undergoing upper and lower abdominal surgery were studied after operation to compare the analgesic effects of sublingual buprenorphine (0.4 mg) and slow release morphine sulphate tablets (MST, 20 mg) given 6 hourly in a double-blind, double-dummy trial. Both MST and buprenorphine produced satisfactory postoperative analgesia but the linear analogue pain scores were significantly lower on the second post operative day with MST.

Topics: Abdomen; Administration, Oral; Adult; Aged; Buprenorphine; Delayed-Action Preparations; Double-Blind Method; Female; Forced Expiratory Volume; Humans; Male; Middle Aged; Morphinans; Morphine; Pain, Postoperative

This study examined the analgesic effect, vital signs and side effects when 0.4 mg doses of buprenorphine were given pre-emptively for the treatment of postoperative pain after elective total hip replacement. Pain intensity, pain relief, retrospective peak pain intensity and pain relief, sedation, vital signs and side effects were measured 1 hour after surgery and then in the morning and evening of the first 2 postoperative days. There was a significant improvement in pain measured over the 3 days, with concomitant reduction in side effects and sedation. However, there was a significant increase in the number of patients with a pulse rate greater than 100 beats per minute. No particular benefit for postoperative pain relief was observed in patients receiving buprenorphine premedication in comparison with those who had received morphine or placebo.

Topics: Administration, Oral; Adult; Aged; Buprenorphine; Female; Hip Prosthesis; Humans; Injections, Intramuscular; Male; Middle Aged; Morphinans; Morphine; Pain, Postoperative; Preanesthetic Medication; Time Factors

A double-blind comparison between buprenorphine and pentazocine was performed in 20 patients using an on demand analgesic system to provide analgesia after operation. The quality of analgesia, assessed subjectively, was good with both drugs and drug consumptions were compatible with previous potency estimates. The mean doses demanded in 24 h of buprenorphine (1.68 mg) and of pentazocine (382 mg) are consistent with those found in other trials although the between-patient variation was five- or six-fold. There was no significant difference in side-effects between the two groups. Buprenorphine and pentazocine may be used successfully in an on demand system to provide relief of severe pain after operation.

Topics: Adolescent; Adult; Aged; Buprenorphine; Cholecystectomy; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Morphinans; Pain, Postoperative; Pentazocine; Self Administration

In a controlled trial epidural buprenorphine was compared with epidural morphine as the sole means of analgesia after major abdominal surgery. Bolus injections of buprenorphine 60 micrograms in 10 ml or morphine 2 mg in 10 ml of normal saline were given on demand for the first 48 hours postoperatively. Both drugs produced significant reduction in pain scores as assessed by the linear visual analogue scale and both produced prolonged analgesia at this dosage, which could be extended by further 'top-ups'. The authors conclude that, for postoperative epidural analgesia, buprenorphine may be the opiate of choice and the reasons for this are discussed.

Topics: Adult; Buprenorphine; Clinical Trials as Topic; Epidural Space; Female; Humans; Injections; Male; Middle Aged; Morphinans; Morphine; Pain, Postoperative; Time Factors

An on demand intramuscular analgesic system using the Cardiff Palliator was tested. Forty consenting patients were studied after cholecystectomy in a double blind trial using increments of buprenorphine (0.15 mg), meptazinol (50 mg), morphine (5 mg), and pethidine (50 mg). Most patients attained good levels of pain relief (mean analogue pain score 36.5), comparable to intravenous on demand analgesia. There were no technical complications. Significant differences were found between drugs in dizziness (pethidine produced the worst score) but not with other side effects. Buprenorphine produced longer lasting analgesia than meptazinol or pethidine and also gave the lowest pain scores. Patterns of analgesic consumption were the same as with intravenous on demand systems, but larger amounts of drug were generally used. Relative analgesic potencies derived from drug consumption rates were also consistent with those from intravenous on demand studies. An on demand intramuscular analgesic system offers a simple but effective means of relieving severe postoperative pain.

Topics: Adolescent; Adult; Aged; Analgesics; Buprenorphine; Cholecystectomy; Clinical Trials as Topic; Dizziness; Double-Blind Method; Female; Humans; Injections, Intramuscular; Male; Meperidine; Meptazinol; Middle Aged; Morphine; Pain, Postoperative

A randomized double-blind study was done to test the two opiates buprenorphine (0.3 mg i.v.) and pentazocine (30 mg i.v.) with regard to their applicability for the postoperative phase. These substances were chosen because they are not subject to drug prescription regulations. 60 patients who had undergone epigastric and hypogastric interventions under thiopental-sodium-induced halothane anesthesia received i.v. injections of one of the two analgetics as soon as they requested a pain-killer postoperatively. The subjective pain intensity registered by means of a visual analogue scale shows a gradual decrease after buprenorphine with maximal effects 1-3 h post injectionem (7.3 leads to 1.5). The duration of action is 8.2 +/- 0.7 h on the average (median 8 h; range 4-22 h). The maximal analgetic effect of pentazocine is already attained after 10 min (6.3 leads to 3.2). Thereafter the pain-intensity curve rises again. Pentazocine has a mean duration of action of 2.35 +/- 0.24 h (median 2 h; range 0.5-5 h). The inadequate analgetic effect of pentazocine manifests itself in an only slight initial reduction of the respiratory rate (19.5 leads to 17.5 min-1), which, on the other hand, decreases significantly and continuously under buprenorphine (20.8 leads to 13.5 min-1). Both substances cause increases of PaCO2 (buprenorphine 37.3 leads to 46.8 mmHg; pentazocine 36.3 leads to 43.0 mmHg), values greater than 50 mmHg being attained in individual cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Abdomen; Adult; Aged; Buprenorphine; Carbon Dioxide; Clinical Trials as Topic; Double-Blind Method; Female; Hemodynamics; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Morphinans; Pain, Postoperative; Pentazocine; Respiration; Time Factors

Two groups of 20 patients each were given immediately after hip-operation an epidural injection of 0,15 or 0,3 mg buprenorphine. Effects and side effects are compared with those observed in two groups of patients having the same type of operation, and given either 4 mg of morphine or saline (placebo) by epidural injection. Buprenorphine in both doses produced a shorter duration of analgesia than 4 mg of morphine. In no case did respiratory depression occur. Urinary retention after buprenorphine was barely more frequent than in the placebo group. Nausea and vomiting occurred in 35-45% of patients. We do not see an advantage in replacing morphine by buprenorphine for epidural opiate-analgesia, because the same high rate of nausea/vomiting is associated with a significantly shorter duration of analgesia after buprenorphine. We are convinced that epidural opiate-analgesia is most valuable for postoperative pain relief but should be reserved for selected cases.

Topics: Aged; Buprenorphine; Epidural Space; Hip Prosthesis; Humans; Injections; Male; Middle Aged; Morphinans; Morphine; Pain, Postoperative

Sixty patients undergoing day-case dental surgery were either given sublingual buprenorphine 0.2 mg or 0.4 mg or a buffered placebo 1 hour prior to general anaesthesia. Pre-operative anxiety was not allayed and there was no significant analgesia afforded by buprenorphine in the immediate postoperative period. The synthetic opiate depressed psychomotor function and both 0.2 mg and 0.4 mg buprenorphine yielded a significantly higher incidence of postoperative nausea and vomiting.

Topics: Adolescent; Adult; Ambulatory Surgical Procedures; Anesthesia, Dental; Anxiety; Blood Pressure; Buprenorphine; Drug Evaluation; Female; Heart Rate; Humans; Male; Middle Aged; Morphinans; Pain, Postoperative; Preanesthetic Medication; Psychomotor Performance; Time Factors

Topics: Adult; Buprenorphine; Clinical Trials as Topic; Female; Genital Diseases, Female; Humans; Meperidine; Morphinans; Morphine; Pain, Postoperative

In a double-blind randomized non-crossover trial 47 patients received either morphine or buprenorphine by regular i.m. injection for 24 h after abdominal surgery. The two drugs were equally effective as analgesics at the doses used. Five in the buprenorphine group and none in the morphine group were excluded because of respiratory depression. Four of these had received opiates during operation. The remainder of the buprenorphine group developed progressively slower respiration rates after 12 h. The results indicate that buprenorphine has a synergistic respiratory depressant effect with fentanyl and phenoperidine and may have a cumulative effect when given regularly on a 6-hourly regimen.

Topics: Adolescent; Adult; Aged; Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Morphinans; Morphine; Pain, Postoperative; Random Allocation; Respiration

The analgesic activity of buprenorphine was monitored versus that of morphine in a double-blind, randomized, multiple-dose, parallel-design study involving 97 postsurgical patients. Patients could receive intramuscular injections of either buprenorphine (0.3, o.45, or 0.6 mg) or morphine (10, 15, or 20 mg) every 3 or more hours. Pain intensity, degree of sedation, vital signs, pain relief, and side effects were assessed prior to and at regular intervals after each drug injection. No statistically significant differences were found between the two drugs in total pain relief, sum of pain intensity difference by patient and over time, time to peak pain intensity difference, duration of pain, and side effects. It has been suggested that the addictive potential of buprenorphine may be less than that of morphine. Since both drugs seem to be effective analgesics, buprenorphine appears to offer an effective and safe alternative to morphine for patients with acute pain.

Topics: Adolescent; Adult; Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Middle Aged; Morphinans; Morphine; Pain, Postoperative; Time Factors

The plasma concentrations and clinical effects of a single i.v. dose of buprenorphine 0.3 or 0.6 mg were studied in patients recovering from surgery. Analgesic and hormonal effects were greater with the greater dose without a parallel increase in respiratory depression. A comparison with previous work suggests that increased efficacy results either from the use of the larger dose or equivalently if the first required postoperative dose of 0.3 mg has been preceded by a similar loading dose.

Topics: Aged; Blood Glucose; Buprenorphine; Female; Humans; Hydrocortisone; Injections, Intravenous; Male; Middle Aged; Morphinans; Pain, Postoperative; Respiration

In 51 patients undergoing elective abdominal surgery, analgesia was provided for the first 24 h after surgery by bolus injections of buprenorphine 0.1 or 0.2 mg given i.v. on patient demand using a patient-operated syringe driver (the "Cardiff" palliator). Excellent analgesia was reported by 47 patients. Four elderly patients had difficulty in operating the demand apparatus. In two other patients, clinically significant ventilatory depression necessitated abandoning the trial. Although there was a high degree of patient and staff acceptance of the method, the potential for ventilatory depression emphasizes the need for close observation of patients receiving i.v. opioids by this technique.

Topics: Adult; Aged; Buprenorphine; Hemodynamics; Humans; Injections, Intravenous; Middle Aged; Morphinans; Pain, Postoperative; Respiration; Self Administration; Time Factors

One hundred and twenty-six patients undergoing upper and lower abdominal surgery were studied after operation to compare the analgesic effects of i.m. morphine, sublingual buprenorphine and self-administered i.v. pethidine by Cardiff Palliator. There were no significant differences between analgesic regimens in respect of subjective linear analogue pain scores or static and dynamic lung volumes assessed at 24 and 48 h after operation and 5 days after operation in patients who underwent upper abdominal surgery. Sublingual buprenorphine produced more nausea and sedation than the other two treatments, but the differences were not clinically important. However, it offered considerable advantages in terms of ease of administration.

Topics: Administration, Oral; Adolescent; Adult; Aged; Buprenorphine; Female; Humans; Injections, Intramuscular; Injections, Intravenous; Male; Meperidine; Middle Aged; Morphinans; Morphine; Pain, Postoperative; Respiratory Function Tests; Self Administration; Tongue

1 A 10 h study of plasma drug concentrations of the opiate buprenorphine after use was designed because a previous 3 h study had shown that peak plasma drug concentrations in some patients had not occurred by 3 h after the sublingual dose. 2 Fifteen postoperative patients were studied: at 3 h after a 0.3 mg intravenous dose five patients received a sublingual preparation of 0.4 mg of buprenorphine, five 0.8 mg of buprenorphine and five placebo. Plasma drug concentrations of buprenorphine were measured by specific radioimmuno-assay. 3 Plasma drug concentrations after sublingual buprenorphine were significantly higher than those in the placebo group by 1 h. They remained significantly higher over the succeeding nine hours. The mean time to peak plasma drug concentration was about 200 min in both the 0.4 mg and 0.8 mg groups (range 90-360 min). The plasma drug concentrations in the 0.8 mg group were approximately twice those in the 0.4 mg group; the ratio of the relative systemic availabilities was similarly 1.8:1. The absolute systemic availability was estimated at about 55% for both groups. Uptake of buprenorphine from the sublingual site was essentially complete by 5 h after the dose was given. 4 The implications for the timing of sublingual doses in clinical use are discussed.

Topics: Aged; Biological Availability; Buprenorphine; Female; Humans; Kinetics; Male; Middle Aged; Models, Biological; Morphinans; Pain, Postoperative; Time Factors; Tongue

Morphine (5 mg) and buprenorphine (0.15 mg) given by the epidural route were compared in 50 patients recovering from abdominal surgery. Pain relief score, sedation score and clinical measures were evaluated in a double-blind study. Both substances produced thorough analgesia with short latency (2-6 min) of long duration (8-9 h). Side effects were encountered in some morphine cases only, but never therapy had to be discontinued. Total lack of side effects with buprenorphine favours its application in epidural pain relief.

Topics: Anesthesia, Epidural; Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Female; Hemodynamics; Humans; Male; Middle Aged; Morphinans; Morphine; Pain, Postoperative; Random Allocation

1 An oral combination of buprenorphine and paracetamol was compared with paracetamol alone in a single dose, double-blind postoperative study. One hundred and twenty patients undergoing elective minor orthopaedic operations were allocated to four groups of 30 patients. The four treatments were 1,1.5 or 2 mg of buprenorphine with paracetamol 1,000 mg or paracetamol 1,000 mg alone. 2 There were no significant differences between the groups in analgesia measured by the observer over the 6 h period of direct observations. The oral opiate produced a significant increase in duration of analgesia beyond the 6 h study period. A significant increase in side-effects was seen only at the highest buprenorphine dose compared with paracetamol. 3 The problems of trial design for analgesic combinations are considered. Drug mixtures create additional complexities which decrease the certainty of the conclusion that no real benefits result from such mixtures.

Topics: Acetaminophen; Adult; Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Female; Humans; Male; Morphinans; Pain, Postoperative

Ninety-eight patients completed a double-blind, multidose, randomized parallel study in which buprenorphine (Temgesic) was compared to morphine. Drugs were administered at approximately equipotent intramuscular doses for a maximum of three days for the relief of moderate to severe postoperative pain. The two drugs exhibited similar profiles with pain relief evident at 1/2 hour, peaking at 1 hour, and decreasing to slight relief at 4-5 hours, with no significant differences for time to remedication. The most frequent side effect was somnolence. One patient suffered sudden chest pain shortly after an injection of morphine, and one patient had moderate hypoventilation after buprenorphine; both patients recovered uneventfully. Overall, both drugs provided good or excellent analgesia in 80 per cent of the patients in this unique multidose/observational study. Thus, these data and the reported lack of withdrawal symptoms and the absence of physical dependence liability suggest that buprenorphine may have a role in the management of chronic pain.

Topics: Adult; Buprenorphine; Double-Blind Method; Drug Evaluation; Female; Humans; Male; Morphinans; Morphine; Pain, Postoperative; Random Allocation

Topics: Adolescent; Adult; Aged; Buprenorphine; Female; Humans; Male; Meperidine; Middle Aged; Morphinans; Pain, Postoperative; Tramadol

The effect of sublingual buprenorphine (0.4 mg) was compared with that of oral dihydrocodeine (60 mg) in patients experiencing post-operative pain following general surgery. Pain relief was significantly greater for buprenorphine than for dihydrocodeine, based on both peak effect and total effect. Both treatments were effective from 30 minutes. There was evidence that buprenorphine and a slightly slower onset of action, but a distinctly longer duration of action, than dihydrocodeine. Unwanted effects were similar for both treatments.

Topics: Administration, Oral; Buprenorphine; Codeine; Female; Humans; Male; Middle Aged; Morphinans; Pain, Postoperative; Random Allocation

Analgesic effects as well as side effects, circulatory and respiratory parameters of 0.3 mg Buprenorphine (Temgesic) were compared to 10 mg Nicomorphine (Vilan) intramuscularly injected in a double-blind, randomized study for the relief of postoperative pain. Buprenorphine produced an equally potent but longer acting analgesic effect compared to Nicomorphine, although slight delayed. There were only few and slight side effects and no influence on the circulation and the respiration. In the search for a new long-acting and strong analgesic Buprenorphine proved to be superior to Nicomorphine in the control of postoperative pain.

Topics: Adult; Buprenorphine; Double-Blind Method; Female; Humans; Injections, Intramuscular; Male; Morphinans; Morphine Derivatives; Nicotinic Acids; Pain, Postoperative

Analgesic effects as well as side effects, circulatory and respiratory parameters of 50 mg tramadol (Tramal) were compared with 0.3 mg buprenorphine (Temgesic) in a doubleblind, randomized study for the relief of postoperative pain. Buprenorphine produced a more potent and longer acting analgesic effect compared to tramadol, although slightly delayed. There were only few and slight side effects and no influence on the circulation and respiration. In the search for a new long-acting and strong analgesic Tramadol proved to be unable to replace buprenorphine in the control of postoperative pain.

Topics: Adult; Blood Pressure; Buprenorphine; Cyclohexanols; Double-Blind Method; Humans; Middle Aged; Morphinans; Pain, Postoperative; Postoperative Period; Pulse; Respiration; Time Factors; Tramadol

Twenty-five women were investigated on the day after lower abdominal surgery in a single-blind non-cross-over trial to assess and compare the haemodynamic effects of intravenous injections of buprenorphine 0.3 mg and morphine 7.5 mg. Arterial blood pressure was measured by sphygmomanometry and cardiac output by thoracic impedance cardiography. Arterial blood pressure was significantly reduced following both drugs (p < 0.05), although the mean decrease in systolic arterial pressure was less than 8 mmHg. However, in one patient in each group the decrease was more than 20 mmHg. Cardiac output decreased but the mean reduction was less than 5%. The greatest individual decreases were 21% after buprenorphine and 30% after morphine. Myocardial contractility, assessed by systolic time indices, did not appear to change. There were no consistent differences in the haemodynamic effects of the two drugs.

Topics: Abdomen; Adult; Buprenorphine; Clinical Trials as Topic; Female; Hemodynamics; Humans; Injections, Intravenous; Middle Aged; Morphinans; Morphine; Pain, Postoperative

The analgesic profile and side-effects of buprenorphine 0.3 mg and morphine 10 mg intramuscularly were compared postoperatively in a double-blind, non-crossover, multiple-dose study. When the patient complained of moderate to severe postoperative pain after halothane-relaxant anesthesia for upper abdominal surgery, the first test dose of either drug was given. Subsequent similar doses of buprenorphine 0.3 mg or morphine 10 mg were given when required (maximum ten doses). The first dose of both drugs gave an equal decrease in pain intensity, suggesting a relative potency of 33:1 for both buprenorphine/morphine. A mean of 0.51 mg buprenorphine or 17 mg morphine had to be administered for satisfactory initial analgesia. Thereafter, the next analgesic dose was required a mean of 10.3 h after buprenorphine compared to 5.9 h after morphine (P less than 0.01). Significantly (P less than 0.01) fewer analgesic doses (mean 5.6) were needed in the buprenorphine group within the first 48 h postoperatively as compared to the morphine group (mean 7.3). A more pronounced mean decrease in the respiratory rate was observed after buprenorphine, but the mean minimum respiratory rates did not differ significantly from each other. Other effects of the two drugs on vital signs were similar. The incidence of other side-effects was fairly similar after both analgesics. The patients' subjective appraisal favoured buprenorphine.

Topics: Adolescent; Adult; Aged; Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Middle Aged; Morphinans; Morphine; Pain, Postoperative; Random Allocation; Time Factors

In 38 patients buprenorphine, meperidine and pentazocine were given in a single dose for postoperative pain relief 20 hours after the end of anaesthesia. Measuring the parameters of the high- and low-pressure system as well as the metabolism the authors found that the effects of these analgetic medicaments, intravenously injected were significantly influenced by fentanyl, halothane or diazepam, given under the course of operation. Especially buprenorphine, injected after epidural anaesthesia in combination with diazepam sedation, proved to have a rather negative effect, because it caused a strong depression of respiration and circulation. On the other hand buprenorphine had, given after neuroleptanaesthesia, a neutralizing - and pentazocine and pethidine in combination with neuroleptanaesthesia a stimulating influence on the circulation. After halothane-anaesthesia the effect of the analegtics on the cardiovascular system was, when buprenorphine was given, depressing and when pentazocine was given indifferent. Similar reactions, but more pronounced, could be seen in the epidural group. With certain reservations, caused by the preliminary character of this study, the following conclusions can be drawn for the anaesthetic practice: 1 Choosing analgetic drugs for postoperative pain relief, the anaesthesist has to be aware of the interactions, possibly resulting from the medicaments, given during anaesthesia. 2. The number of medicaments, given during anaesthesia, should be kept small, considering the eventual interactions and the unintentional secondary effects.

Topics: Aged; Analgesics; Anesthesia, Epidural; Buprenorphine; Diazepam; Drug Interactions; Female; Fentanyl; Halothane; Hemodynamics; Humans; Male; Meperidine; Middle Aged; Pain, Postoperative; Pentazocine; Respiration

In a double-blind study of on-demand intravenous analgesia buprenorphine was found to be about 600 times as potent as pethidine. The incidence of side effects was similar with both drugs. The quality of analgesia, subjectively assessed, was good with both drugs using this method of administration. Provided that its low potential for abuse is substantiated, buprenorphine appears to be a powerful analgesic that may successfully be given intravenously on demand.

Topics: Adolescent; Adult; Aged; Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Humans; Injections, Intravenous; Meperidine; Middle Aged; Morphinans; Pain, Postoperative

The analgesic effects of sublingually administered buprenorphine 0.4 mg have been compared with morphine 10 mg given intramuscularly in patients following operation. The results indicate a slower onset of action for buprenorphine but of much longer duration than morphine. There were no serious side effects or difference in their incidence between the two drugs.

Topics: Administration, Oral; Adult; Buprenorphine; Drug Evaluation; Humans; Morphinans; Morphine; Mouth Floor; Pain, Postoperative

Management of patients with opioid use disorder during the acute postpartum period remains clinically challenging as obstetricians aim to mitigate postdelivery pain while optimizing recovery support.. This study aimed to evaluate postpartum opioid consumption and opioids prescribed at discharge among patients with opioid use disorder treated with methadone, buprenorphine, and no medication for opioid use disorder, as compared with opioid-naïve counterparts.. We conducted a retrospective cohort study of pregnant patients who underwent delivery at >20 weeks' gestation at a tertiary academic hospital between May 2014 and April 2020. The primary outcome of this analysis was the mean daily quantity of oral opioids consumed after delivery while inpatient, in milligrams of morphine equivalents. Secondary outcomes included the following: (1) quantity of oral opioids prescribed at discharge, and (2) prescription for oral opioids in the 6 weeks after hospital discharge. Multiple linear regression was used to compare differences in the primary outcome.. A total of 16,140 pregnancies were included. Patients with opioid use disorder (n=553) consumed 14 milligrams of morphine equivalents per day greater quantities of opioids postpartum than opioid-naïve women (n=15,587), (95% confidence interval, 11-17). Patients with opioid use disorder undergoing cesarean delivery consumed 30 milligrams of morphine equivalents per day greater quantities of opioids than opioid-naïve counterparts (95% confidence interval, 26-35). Among patients who underwent vaginal delivery, there was no difference in opioid consumption among patients with and without opioid use disorder. Compared with patients prescribed methadone, patients prescribed buprenorphine, and those prescribed no medication for opioid use disorder consumed similar opioid quantities postpartum following both vaginal and cesarean delivery. Among patients undergoing cesarean delivery, opioid-naïve patients were more likely to receive a discharge prescription for opioids than patients with opioid use disorder (77% vs 68%; P=.002), despite lower pain scores and less inhospital opioid consumption.. Patients with opioid use disorder, regardless of treatment with methadone, buprenorphine, or no medication for opioid use disorder consumed significantly greater quantities of opioids after cesarean delivery but received fewer opioid prescriptions at discharge.

Topics: Analgesics, Opioid; Buprenorphine; Drug Prescriptions; Female; Humans; Methadone; Morphine Derivatives; Opioid-Related Disorders; Pain, Postoperative; Patient Discharge; Postpartum Period; Pregnancy; Retrospective Studies

To determine if postoperative gabapentin administration is associated with decreased opioid consumption or pain scores following cesarean delivery in women on chronic buprenorphine.. Retrospective cohort study.. Postoperative recovery area and postpartum inpatient unit.. 214 women undergoing cesarean delivery while on chronic buprenorphine at a single institution between 2007 and 2017.. Gabapentin treatment for post-cesarean analgesia.. The primary outcome was opioid consumption in morphine milligram equivalents, comparing patients who received ≥1 dose of gabapentin within 24 h of cesarean delivery to those who did not. Secondary outcomes included opioid consumption 24-48 and 48-72 h post-cesarean and postoperative numerical rating scale pain scores.. Of 214 included patients, 64 (30%) received gabapentin while 150 (70%) did not. Gabapentin patients were more likely than controls to have received neuraxial fentanyl (30% vs. 14%, p = 0.01) and transversus abdominis plane block (6% vs. 1%, p = 0.05) and overall received higher doses of ketorolac and acetaminophen. Control patients were more likely to have received neuraxial morphine (78% vs. 90%, p = 0.04) and received higher doses of ibuprofen. In unadjusted analysis, there was no significant difference in morphine milligram equivalent consumption 0-24 h postoperatively between gabapentin (55 mg [IQR 26,84]) and control (53 mg [IQR 28,75]) groups (p = 0.38). After controlling for potential confounders, there remained no significant effect of gabapentin administration (overall effect p = 0.99). Opioid consumption and pain scores were also not significantly different at any other time points.. In parturients receiving chronic buprenorphine, inclusion of gabapentin in a multimodal analgesic regimen was not associated with lower opioid consumption or pain scores during the first 72 h after cesarean delivery. Prospective randomized studies are needed to confirm these findings.

Topics: Analgesics, Opioid; Buprenorphine; Female; Gabapentin; Humans; Morphine; Pain, Postoperative; Pregnancy; Prospective Studies; Retrospective Studies

Buprenorphine is a partial agonist at mu-opioid receptors and competes for these receptors with other opioids in vitro. Whether patients on buprenorphine maintenance require high doses of opioid analgesics to attain adequate postoperative pain control has not been determined. We evaluated differences in acute postoperative opioid consumption and pain burden between patients taking buprenorphine and those taking methadone preoperatively.. A retrospective review of medical records of 928 patients, of whom 195 were on buprenorphine and 733 were on methadone preoperatively, was performed. Among methadone and buprenorphine patients, 615 and 89, respectively, continued to receive the medications postoperatively. Buprenorphine patients were compared with methadone patients for the first 48 hours postoperatively with regard to acute opioid dose requirements (morphine milligram equivalents [MME] above their baseline buprenorphine and methadone doses) and time-weighted average (TWA) pain scores (using targeted maximum likelihood estimation).. Opioid dose requirements for 48 hours postoperatively were 150 (22 to 297) (median [interquartile range]) and 220 [90 to 360] MME for buprenorphine and methadone patients, respectively. Preoperative buprenorphine was associated with a 59.9% lower postoperative MME (95% confidence interval: 46.6%-69.8%, P<0.0001) compared with methadone. Postoperative TWA pain scores for the first 48 hours were 5.0±2.7 (mean±SD), and 5.4±2.3 for buprenorphine and methadone patients, respectively. Preoperative buprenorphine was associated with a 0.37-point lower TWA pain score (95% confidence interval: 0.14-0.61, P=0.002) compared with methadone.. Preoperative buprenorphine use was associated with >50% reduction in postoperative opioid dose requirement and a statistically significant, though clinically unimportant, reduction in acute pain burden in comparison to methadone. The study is limited by several important factors such as the exclusion of patients requiring intravenous patient-controlled analgesia, small number of patients were on higher dose of buprenorphine, and a large percentage of methadone patients were not on a stable dose of methadone yet.

Topics: Analgesics, Opioid; Buprenorphine; Humans; Methadone; Opioid-Related Disorders; Pain, Postoperative; Retrospective Studies

Topics: Analgesics, Opioid; Buprenorphine; Cardiac Surgical Procedures; Humans; Nerve Block; Pain Management; Pain, Postoperative

Topics: Analgesics, Opioid; Animals; Buprenorphine; Delayed-Action Preparations; Laparotomy; Male; Mice; Mice, Inbred C57BL; Pain Measurement; Pain, Postoperative; Rats

Topics: Analgesics; Analgesics, Opioid; Animals; Buprenorphine; Catheterization; Delayed-Action Preparations; Female; Male; Mice; Mice, Inbred C57BL; Pain, Postoperative; Rats

Topics: Analgesics; Analgesics, Opioid; Animals; Buprenorphine; Delayed-Action Preparations; Female; Male; Mice; Pain Measurement; Pain, Postoperative; Saline Solution

With ongoing animal welfare efforts, multimodal analgesia is often recommended to implement in study protocols. Buprenorphine with very potent analgesic effect is a standard opioid for the use in this context in rats. In this study, two rat strains (LEW/NHanZtm, n = 6 and Crl:CD(SD), n = 8) underwent orthopaedic surgery and received carprofen, buprenorphine and a local anaesthetic in a multimodal setup. Crl:CD(SD) rats showed severe side effects in the first 24 h after anaesthesia, predominantly manifesting in pica-behaviour and reaching humane endpoints in two of eight animals, while LEW/NHanZtm rats showed only slight depression in the first postoperative days. In the context of improving animal welfare in experimental studies, buprenorphine is highly recommended not to be used in male Crl:CD(SD) rats and should generally be used very carefully and only if required.

Topics: Analgesia; Analgesics; Analgesics, Opioid; Animals; Buprenorphine; Male; Pain Measurement; Pain, Postoperative; Rats; Rodent Diseases

Opioids, the frontline drugs for postsurgical analgesia, have been linked to diversion and abuse with lethal consequences. The search for safe analgesics with less harm potential has been decades long. However, clinical trials for safe opioid and nonopioid analgesics have relied on subjective pain reports, which are biased by placebo effects that increase the complexity of trials to develop new therapies to manage pain. Research in opioid naïve animals and humans demonstrates that blood concentrations of opioids that effectively saturate the morphine opioid receptor are tightly linked with patient reports and quantitative sensory tests for analgesia. Opioid drug concentrations can predict clinical responses. This report reviews preclinical and clinical evidence correlating buprenorphine pharmacokinetics with analgesia. More than 30 years of data confirm buprenorphine blood concentrations can be an objective biomarker of analgesia for moderate to severe acute postoperative pain.

Topics: Analgesia; Analgesics, Opioid; Biomarkers; Buprenorphine; Humans; Pain, Postoperative

This study compared opioid utilization and clinical outcomes in surgical patients receiving maintenance buprenorphine therapy who discontinued versus those who continued buprenorphine treatment perioperatively. Lack of high-quality evidence, conflicting results in previous studies, and the possible need for reinduction after discontinuing therapy present clinicians with the complicated dilemma of choosing the best strategy to control post-operative pain in patients receiving buprenorphine.. A multicenter, retrospective cohort study.. Hospitalized patients between January 1, 2017 and December 12, 2019 who underwent any type of surgery, had a documentation of an outpatient buprenorphine prescription or inpatient order, and received buprenorphine for 5 or more days prior to the procedure were included.. The primary objective was to compare mean 24-hour morphine milligram equivalent (MME) utilization post-operatively between patients who discontinued buprenorphine preoperatively versus those who continued therapy throughout the perioperative period.. Fifty-one patients met the inclusion criteria for this study. Of these, 42 patients were continued on buprenorphine through surgery, while nine patients had a documentation of discontinuation preoperatively. The 24-hour post-operative MME utilization (interquartile range) was 58.8 (18-100.8) in patients who continued therapy through surgery versus 152.6 (114.5-236) in patients who discontinued therapy preoperatively (p = 0.005). There were no significant differences in post-operative pain scores or length of stay between groups.. Post-operative opioid use was significantly lower in patients who continued buprenorphine compared with those who discontinued buprenorphine preoperatively.

Topics: Analgesics, Opioid; Buprenorphine; Humans; Opioid-Related Disorders; Pain Management; Pain, Postoperative; Retrospective Studies

There is limited evidence and no clear consensus suggesting best practices for perioperative buprenorphine management in patients with opioid use disorder. As such, we aimed to develop a standardized perioperative management approach with the goals of (1) optimizing perioperative analgesia, (2) minimizing relapse risk, (3) setting expectations for patients and clinicians, (4) achieving prescribing consistency and mitigating risk among clinicians not familiar with perioperative buprenorphine management, and (5) maintaining continuity throughout care transitions. An interprofessional expert focus group convened to develop a consensus algorithm based upon buprenorphine's unique pharmacologic features and published perioperative management recommendations. The resulting consensus algorithm continues the patient's home buprenorphine dose in order to minimize relapse risk, but utilizes a divided dose approach starting the day of surgery if moderate to severe post-operative pain is expected. This strategy leverages the analgesic effects of buprenorphine while allowing for additional opioid binding to optimize analgesia. A patient-centered multimodal perioperative approach including local and/or regional anesthetics and nonopioid adjuncts is employed. Post-operative care is optimized by preoperative planning, including standardized patient assessment, perioperative communication with the buprenorphine prescriber, and education for patients and clinicians. Overall, integrating an understanding of pharmacology and clinical impact through the use of a readily adaptable algorithm such as the divided dose approach is key to optimizing patient care in this high-risk population.

Topics: Analgesics, Opioid; Buprenorphine; Humans; Opioid-Related Disorders; Pain Management; Pain, Postoperative

Pain management following spine surgery can be challenging as patients routinely suffer from chronic pain and opioid tolerance. The increasing popularity of buprenorphine use for pain management in this population may further complicate perioperative pain management due to the limited efficacy of other opioids in the presence of buprenorphine. This study describes perioperative management and outcomes in patients on chronic buprenorphine who underwent elective inpatient spine surgery.. The authors performed a retrospective chart review of all patients >18 years of age taking chronic buprenorphine for any indication who had elective inpatient spine surgery at a single institution. Perioperative pain management data were analyzed for all patients who underwent spine surgery and were maintained on buprenorphine during their hospital stay.. The study was performed at a single tertiary academic medical center.. The primary outcome measures were post-operative pain scores and analgesic medication requirements.. Twelve patients on buprenorphine underwent inpatient spine surgery. Acceptable pain control was achieved in all cases. Management included preoperative dose limitation of buprenorphine when indicated and the extensive use of multimodal analgesia.. The question whether patients presenting for painful, elective surgery should continue using buprenorphine perioperatively is an area of controversy, and the present manuscript provides more evidence for the concept of therapy continuation with buprenorphine.

Topics: Analgesics, Opioid; Buprenorphine; Chronic Pain; Drug Tolerance; Humans; Pain, Postoperative; Retrospective Studies

To test the hypothesis that patients who continued buprenorphine postoperatively experience less severe pain and require a smaller dose of opioids than those who discontinued buprenorphine.. This is a retrospective cohort study of surgical patients who were on buprenorphine preoperatively. Using our previous study's data as pilot data, we selected the covariates to be included in 2 regression models with postoperative time-weighted average pain score and opioid dose requirements in morphine milligram equivalents during 48 hours after surgery as the outcomes. Both contained preoperative daily buprenorphine dose, whether buprenorphine was continued postoperatively, and the preoperative daily dose-by-postoperative continuation interaction as predictors. Precision variables were identified by exhaustive search of perioperative parameters with the exposure variables (preoperative daily dose, postoperative continuation, and their interaction) included in the regression model. The model selected by using the pilot data was estimated again using the new data extracted for this study to make inference about the effect of the 2 exposures (postoperative buprenorphine continuation and preoperative daily buprenorphine dose) and their interaction on the outcomes.. Continuing buprenorphine was associated with a 1.3-point lower time-weighted average pain score than discontinuing (95% confidence interval, 0.39-2.21; P=0.005) but was not associated with a difference in opioid dose requirements (P=0.48).. Continuing buprenorphine was associated with lower postoperative pain levels than discontinuing. Our results were primarily driven by patients on lower buprenorphine dose as only 22% of patients were on daily doses of 24 mg or above.

Topics: Analgesics, Opioid; Buprenorphine; Humans; Opioid-Related Disorders; Pain, Postoperative; Retrospective Studies

We evaluated a potential association between the administration of high-dose buprenorphine and perpetuation of hyperthermia in cats following ovariohysterectomy (OVH). We hypothesized that buprenorphine 0.24 mg/kg subcutaneously (SC) would result in longer-lasting postoperative hyperthermia in cats vs a group receiving morphine 0.1 mg/kg SC.. Anesthetic records from cats admitted for OVH as part of surgical exercises for second year veterinary medicine students in 2018 and 2019 were collected. All cats were sedated with dexmedetomidine 20 µg/kg and morphine 0.1 mg/kg intramuscularly. Anesthesia was induced with propofol and maintained with isoflurane in oxygen. At extubation, cats received morphine 0.1 mg/kg SC in 2018 and buprenorphine 0.24 mg/kg SC in 2019. Temperature was measured rectally prior to sedation, esophageally during anesthesia and rectally at 1, 4 and 16-20 h after extubation. Demographic data and temperature prior to administration of postoperative opioids were compared with. Buprenorphine 0.24 mg/kg SC for postoperative analgesia in cats was associated with hyperthermia that persisted for 16-20 h after administration, and the incidence of hyperthermia for this group was higher than in the cats that received morphine 0.1 mg/kg SC.

Topics: Analgesics, Opioid; Anesthesia; Animals; Buprenorphine; Female; Hyperthermia; Ovariectomy; Pain, Postoperative; Retrospective Studies

Despite the need for safe and effective postoperative analgesia in neonates, research regarding pain management in neonatal rodents is relatively limited. Here, we investigate whether sustained release buprenorphine (Bup SR) effectively attenuates thermal hypersensitivity in a neonatal rat model of incisional pain. Male and female postnatal day 3 Sprague Dawley rat pups (n = 34) were randomly assigned to one of four treatment groups: 1) saline (control), 0.1 mL, once subcutaneously (SC); 2) buprenorphine HCl (Bup HCl), 0.05 mg/kg, once SC; 3) low dose Bup SR (low-SR), 0.5 mg/kg, once SC; 4) high dose Bup SR (high-SR), 1 mg/kg, once SC. Pups were anesthetized with sevoflurane and a 0.5-cm long skin incision was made over the left lateral thigh. The underlying muscle was dissected and closed using surgical glue. Thermal hypersensitivity testing was performed at 24 h prior to surgery and subsequently at 1, 4, 8, 24, and 48 h post-surgery using an infrared diode laser. Thermal hypersensitivity was attenuated at 1 h post-surgery in the Bup HCl group, while it was attenuated through the entire postoperative period in both low-SR and high-SR groups. This data suggests that a single dose of low-SR (0.5 mg/kg) or high-SR (1 mg/kg) effectively attenuates thermal hypersensitivity for at least 8 h in neonatal rat pups.

Topics: Animals; Animals, Newborn; Body Weight; Buprenorphine; Delayed-Action Preparations; Female; Male; Pain, Postoperative; Rats; Rats, Sprague-Dawley; Sex Characteristics; Skin Temperature

Topics: 4-Butyrolactone; Animals; Buprenorphine; Female; Hyperalgesia; Male; Meloxicam; Nociception; Pain, Postoperative; Rats; Rats, Sprague-Dawley; Sulfones

This single-center retrospective study assessed pain management between patients being treated for SUD and compared them to those without SUD who underwent orthopedic surgery. Patients with SUD could be admitted for any reason, while the control arm consisted of patients undergoing total knee arthroplasty or hip arthroplasty surgery. Primary endpoints were average pains scores and morphine milligram equivalents (MME) over the first 48h. Secondary endpoints include adjuvant pain medications and the average MME prescribed upon discharge. A total of the 60 patients were enrolled, 30 patients had history of SUD and 30 patients in the control arm. Average MME between the SUD and control was not significantly different (139.9 mg vs. 96.6 mg, p = 0.889). Average pain scores between the groups were significantly different (7.46 vs. 5.94, p = 0.002). Patients with SUD were not given a statistically different amount of MME for acute pain and experienced higher pain scores than patients without SUD. However, this study had a small population size, and further case-control studies are needed to confirm this result.

Topics: Analgesics, Opioid; Buprenorphine; Humans; Methadone; Opioid-Related Disorders; Pain Management; Pain, Postoperative; Retrospective Studies

Buprenorphine is a partial-agonist opioid that is prescribed as a medication-assisted treatment (MAT) for opioid use disorder (OUD). Buprenorphine is also a potent analgesic with high opioid-receptor affinity and binding coefficient; when buprenorphine is administered simultaneously with a μ-opioid receptor full agonist ("full agonist opioid" [FAO]), the combination can yield unexpected outcomes depending on dosing and timing. Buprenorphine is sometimes perceived as a powerful competitive opioid blocker that will hamper pharmacologic management that necessitates the use of FAO. When patients receiving buprenorphine-MAT (BUP-MAT) formulations have presented for operative procedures, there has been clinical variance in approach to their BUP-MAT management. Recognizing the risk management challenge from both analgesia and BUP-MAT perspectives, we convened a multidisciplinary group of clinicians who treat BUP-MAT patients and completed a literature review with the goal of generating a guideline for appropriate management of these patients presenting for a broad spectrum of surgical procedures. Our conclusion is that continuous simultaneous administration of buprenorphine products with FAO is safe when accounting for dose and timing, including surgeries that historically produce moderate to severe pain, and may further provide an analgesic advantage, lessen FAO burden, and reduce relapse risk to this group.

Topics: Buprenorphine; Drug Administration Schedule; Humans; Naloxone; Narcotic Antagonists; Opiate Substitution Treatment; Opioid-Related Disorders; Pain, Postoperative; Perioperative Care; Practice Guidelines as Topic

Objectively recognizing postoperative pain in mice is challenging, making it difficult to determine an appropriate postoperative analgesic regimen. Adult male mice produce ultrasonic vocalizations after exposure to adult female urine (FiUSV). To determine if FiUSV can be used as a indicator of postoperative pain, FiUSV produced by male C57BL/6J mice were assessed for 5 d before and after vasectomy or sham surgery with or without sustained-release buprenorphine. Postoperative pain was assessed by monitoring vocalization using an ultrasonic microphone and by evaluating orbital tightness, posture, and piloerection at postoperative time points. Before vasectomy or sham surgery, 25 of 38 male mice produced FiUSV on 4 of 5 d (143 ± 93 FiUSV). Vasectomized mice without postoperative analgesia produced significantly fewer FiUSV (59 ± 26 FiUSV) compared with baseline (212 ± 102 FiUSV) at 4 h postoperatively, but returned to baseline by 28 h. Vasectomized mice treated with buprenorphine and sham-surgery mice had no change in FiUSV from baseline at any time point after surgery. Activity was decreased compared with baseline in vasectomized mice, regardless of receiving postoperative analgesia or not, but only at the 4-h time point. There were no differences in behavior scores between vasectomized mice and sham-surgery mice at any time point. These results show that FiUSV can be used to detect postoperative pain in male C57BL/6J mice after vasectomy.

Topics: Analgesics, Opioid; Animals; Buprenorphine; Female; Humans; Male; Mice; Mice, Inbred C57BL; Pain Measurement; Pain, Postoperative; Postoperative Period; Ultrasonics; Vasectomy; Vocalization, Animal

Providing postoperative analgesia to rats by oral administration, compared with injections, reduces stress from frequent handling and is technically easier for investigators. The purpose of this study was to investigate whether bacon-flavored tablets containing gabapentin, carprofen or a combination of both drugs effectively attenuates postoperative mechanical and thermal hypersensitivity in a rat model of incisional pain. Forty-eight Sprague-Dawley rats were randomly assigned to 1 of 5 treatment groups: placebo tablet; a single, subcutaneous injection of buprenorphine sustained release at 1.2 mg/kg; gabapentin 90 mg/tablet; carprofen 5 mg/tablet; gabapentin 90 mg and carprofen 5 mg/tablet (gabapentin/carprofen). Tablets were given to rats on days -3, -2, -1, 0 (surgery), 1, and 2. Rats were anesthetized using isoflurane. A 1 cm skin incision was made aseptically on the plantar surface of the left hindpaw and closed by using suture. Mechanical (von Frey monofilament) and thermal (Hargreaves method) hypersensitivity were tested daily, and analyzed on days -1, 1, 2, and 3. The amount of tablet consumed was recorded daily; postoperatively rats consumed 101 to 133 mg/kg of gabapentin, 5.5 to 5.8 mg/kg of carprofen, and 86-137/1.9-3 mg/kg of gabapentin/carprofen, respectively. Both the gabapentin and carprofen groups displayed attenuated mechanical hypersensitivity on all 3 postsurgical days and decreased thermal hypersensitivity on Day 3. The gabapentin/ carprofen group showed attenuated mechanical hypersensitivity on Day 2 and 3, but no significant reduction of thermal hypersensitivity. These data suggest that both gabapentin and carprofen, given orally by flavored tablet, effectively attenuate postoperative mechanical hypersensitivity for 3 d after surgery in a rat model of incisional pain.

Topics: Analgesics; Animals; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Carbazoles; Drug Therapy, Combination; Flavoring Agents; Gabapentin; Laboratory Animal Science; Male; Pain, Postoperative; Postoperative Period; Rats; Rats, Sprague-Dawley; Surgical Wound; Tablets

An increasing number of individuals are prescribed buprenorphine as medication-assisted treatment for opioid use disorder. Our institution developed guidelines for perioperative buprenorphine continuation with an algorithm for dose reduction based upon the surgical procedure and patient's maintenance dose. The objective of this study was to compare the effects of buprenorphine continuation with those of discontinuation on postoperative pain scores and outpatient opioid dispensing.. Retrospective observational study.. Surgical patients on buprenorphine from March 2018 to October 2018. Patients on buprenorphine for chronic pain and those with minor procedures were excluded from analysis.. We compared postoperative outpatient opioid dispensing and postanesthesia care unit (PACU) pain scores in patients where buprenorphine was continued compared with held perioperatively, collecting single surgical subspecialty prescriber data on outpatient full mu-opioid agonist prescriptions dispensed, converted into mean morphine equivalents. Buprenorphine formulations were not included in our morphine milligram equivalents (MME) total.. There were 55 patients total (38 cont. vs 17 held). There was no difference in postoperative buprenorphine treatment adherence (91% cont. vs 88% held, P = 0.324). The number of opioid prescriptions dispensed was significantly higher with buprenorphine discontinuation (53% cont. vs 82% held, P = 0.011), as was MME dispensed (mean of 229 cont. vs mean of 521 held, P = 0.033). PACU pain scores were higher with buprenorphine discontinuation (mean 2.9 cont. vs mean 7.6 held, P < 0.001).. There was a significant reduction in opioid prescriptions filled, MME dispensed, and PACU pain scores in patients where buprenorphine was continued vs held perioperatively. We provide evidence to support that buprenorphine can be continued perioperatively and that continuation is associated with decreased postoperative pain and decreased outpatient opioid dispensing. These results contribute to the existing literature supporting the perioperative continuation of buprenorphine.

Topics: Analgesics, Opioid; Buprenorphine; Humans; Opioid-Related Disorders; Outpatients; Pain, Postoperative

Sustained-release buprenorphine is widely used in mice with the intention of providing long-lasting analgesia. Statements about duration of therapeutic efficacy are based on persistence of serum buprenorphine levels over a minimum threshold, but behavioral data demonstrating sustained efficacy is not established. Additionally, chronic opioid exposure can induce tolerance and/or hyperalgesia; mice receiving sustained-release buprenorphine have not been evaluated for these effects. This study assessed clinical efficacy and duration of sustained-release buprenorphine in inflammatory, post-operative, and cancer pain; and screened for centrally-mediated opioid-induced hyperalgesia as well as opioid tolerance. At 1-2 mg/kg sustained-release buprenorphine, statistically significant analgesic efficacy occurred only at time points up to 2 h. These animals showed no changes in von Frey thresholds on the contralateral side, i.e. no centrally-mediated opioid hyperalgesia. To establish whether acute onset opioid tolerance resulted from a single sustained-release buprenorphine administration, we used the tail flick assay, exposing mice to sustained-release buprenorphine or saline on Day 1 and buprenorphine on Day 2. We measured duration and efficacy of 1 mg/kg buprenorphine after 1 mg/kg sustained-release buprenorphine, and also quantified a dose-response curve of buprenorphine (0.1-3 mg/kg) after 2 mg/kg sustained-release buprenorphine. Compared to control animals, mice previously exposed to sustained-release buprenorphine showed diminished analgesic response to buprenorphine; the resultant dose-response curve showed decreased efficacy. Pretreatment with naloxone, an opioid receptor antagonist, blocked sustained-release buprenorphine analgesic action. The short duration of antinociception following administration of sustained-release buprenorphine in mice is caused by the rapid development of tolerance.

Topics: Analgesics, Opioid; Animals; Buprenorphine; Cancer Pain; Delayed-Action Preparations; Dose-Response Relationship, Drug; Drug Tolerance; Hyperalgesia; Male; Mice; Mice, Inbred C3H; Naloxone; Narcotic Antagonists; Pain Measurement; Pain, Postoperative

In the development of cancer therapeutics, no suitable replacements for the use of animals that are capable of modeling such complex disease processes are currently available. In orthotopic models, surgery is often required to access the target organ for tumor cell inoculation. Historically analgesics have been withheld in such models in light of potential effects on tumor development. The current study evaluated the effect of the opioid buprenorphine on tumor growth of a human ovarian cancer cell line (OVCAR5 OT luc2 mCherry). Female CB17 SCID mice (

Topics: Analgesia; Analgesics, Opioid; Animals; Buprenorphine; Female; Humans; Laboratory Animal Science; Mice; Mice, SCID; Ovarian Neoplasms; Pain; Pain Management; Pain, Postoperative

The principles of Refinement, Replacement and Reduction (3R's) should be taken into account when animals must be used for scientific purpose. Here, a Reduction / Refinement approach was applied to the procedure of spinal cord injury (SCI), an animal model used in rehabilitation medicine research, in order to improve the quality of experiments, avoiding unnecessary suffering. The aims of this investigation were 1- to assess acute surgical pain in mice subjected to SCI, 2- to compare the efficacy of commonly used analgesia (three buprenorphine subcutaneous injection in 48 hours, 0,15 mg/kg each) with a combination of opioid and NSAID (one subcutaneous injection of 5 mg/kg carprofen before surgery followed by three buprenorphine subcutaneous injection in 48 hours, 0,15 mg/kg each) and 3- to test if Infrared Thermography (IRT) could be a potential new Refinement method to easily assess thermoregulation, an important metabolic parameter. Finally, we aimed to achieve these goals without recruiting animals on purpose, but using mice already scheduled for studies on SCI. By using behaviours analysis, we found that, despite being commonly used, buprenorphine does not completely relieve acute surgical pain, whereas the combination of buprenorphine and carprofen significantly decreases pain signs by 80%. IRT technology turned out to be a very useful Refinement tool being a non invasive methods to measure animal temperature, particularly useful when rectal probe cannot be used, as in the case of SCI. We could find that temperatures constantly and significantly increased until 7 days after surgery and then slowly decreased and, finally, we could observe that in the buprenorphine and carprofen treated group, temperatures were statistically lower than in the buprenorphine-alone treated mice. To our knowledge this is the first work providing an analgesic Refinement and a description of thermoregulatory response using the IRT technology, in mice subjected to SCI.

Topics: Analgesics; Analgesics, Opioid; Animals; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Carbazoles; Disease Models, Animal; Infrared Rays; Male; Mice; Mice, Inbred C57BL; Pain Measurement; Pain, Postoperative; Rehabilitation Research; Spinal Cord Injuries; Thermography

Topics: Analgesics, Opioid; Buprenorphine; Buprenorphine, Naloxone Drug Combination; Humans; Opiate Substitution Treatment; Opioid-Related Disorders; Pain Management; Pain, Postoperative; Perioperative Period

Topics: Algorithms; Analgesics, Opioid; Anti-Bacterial Agents; Buprenorphine; Drug Combinations; Endocarditis; Female; Humans; Inpatients; Morphine; Naloxone; Narcotic Antagonists; Opioid-Related Disorders; Pain, Postoperative; Sepsis; Young Adult

Topics: Analgesics, Opioid; Buprenorphine; Humans; Pain, Postoperative; Perioperative Care

The ongoing opioid epidemic has necessitated increasing prescriptions of buprenorphine, which is an evidence-based treatment for opioid use disorder, and also shown to reduce harms associated with unsafe opioid administration. A systematic review of perioperative management strategies for patients taking buprenorphine concluded that there was little guidance for managing buprenorphine perioperatively. The aim of this project is to develop consensus guidelines on the optimal perioperative management strategies for this group of patients. In this paper, we present the design for a modified Delphi technique that will be used to gain consensus among patients and multidisciplinary experts in addiction, pain, community and perioperative medicine.. Institutional research ethics board provided a waiver for this modified Delphi protocol. We plan on developing a national guideline for the management of patients taking buprenorphine in the perioperative period that will be generalisable across three sets of preoperative diagnoses including opioid use disorder and/or co-occurring pain disorders. The findings will be published in peer-reviewed publications and conference presentations.

Topics: Buprenorphine; Consensus; Delphi Technique; Humans; Opiate Substitution Treatment; Opioid-Related Disorders; Pain Management; Pain, Postoperative; Perioperative Care

There is a growing interest in the use of voluntarily displayed ongoing behaviours in laboratory animals to assess the pain experience. In rats, two behavioural pain scales, the Rat Grimace Scale (RGS, a facial expression scale) and a composite behaviour score (CBS, a behavioural ethogram reliant on postural changes), are both promising pain assessment methods. Both scales have been used to assess pain in a laparotomy model, however, they have never been compared directly and the knowledge of how different analgesics may affect these two scales is limited. This study aimed to provide a comparison to discriminate the temporal and analgesic response in a laparotomy model. Female Wistar (n = 26) and Sprague Dawley rats (n = 26) were block randomized to receive saline, meloxicam (2 mg/kg) or buprenorphine (0.05 mg/kg) 30 minutes before laparotomy. Rats were video-recorded before surgery (BL) and at 30, 150, 270, and 390 minutes post-operatively. Videos were assessed according to both scales by a trained, blinded observer. Both CBS and RGS scores increased significantly at all post surgical timepoints in the saline group. Both buprenorphine and meloxicam reduced CBS scores to baseline levels following laparotomy; however, RGS scores were only reduced following buprenorphine. RGS scores in the meloxicam group remained similar to scores of the saline group. These findings suggest that the CBS and RGS differ in their sensitivity to discriminating analgesic effects.

Topics: Animals; Buprenorphine; Facial Expression; Female; Laparotomy; Meloxicam; Pain Measurement; Pain, Postoperative; Posture; Rats; Rats, Sprague-Dawley; Rats, Wistar

Management of labor analgesia and post-cesarean delivery pain is challenging in the patient taking buprenorphine as opioid addiction maintenance therapy. We observed whether substituting clonidine for fentanyl in an epidural solution would provide adequate analgesia for labor and after cesarean delivery.. We substituted our standard 2 µg/mL fentanyl in 0.0625% bupivacaine epidural solution with 2 µg/mL clonidine in 0.0625% bupivacaine, or 1.2 µg/mL clonidine in 0.1% bupivacaine, for labor and post-cesarean analgesia in parturients on buprenorphine therapy. All cesarean deliveries were performed with a combined spinal-epidural technique and the catheters maintained for immediate postoperative analgesia using an epidural infusion. Catheters were discontinued the next day and patients were then managed with other analgesics based on obstetric preference. We recorded pain scores during labor and in the immediate post-surgical period; and supplemental medications given after epidural catheter removal.. Fourteen patients were included in the study, of whom seven presented in spontaneous labor and seven had elective cesarean delivery. All laboring patients achieved good analgesia, and five of seven avoided supplemental opioid use in the postpartum phase. Of the postsurgical patients, six of seven had pain scores less than 5/10 at epidural catheter removal and three of seven avoided supplemental opioids postoperatively.. The combination of clonidine and bupivacaine appears effective in parturients on buprenorphine therapy for opioid addiction maintenance. As study numbers were small and several factors were not examined, further confirmatory research is needed, including to determine the ideal dose of epidural clonidine in this setting.

Topics: Adrenergic alpha-Agonists; Adult; Analgesia, Epidural; Analgesia, Obstetrical; Buprenorphine; Catheterization; Cesarean Section; Clonidine; Delivery, Obstetric; Female; Humans; Narcotics; Opiate Substitution Treatment; Opioid-Related Disorders; Pain Management; Pain Measurement; Pain, Postoperative; Pregnancy; Young Adult

Topics: Analgesia; Buprenorphine; Humans; Pain Management; Pain, Postoperative

Topics: Analgesics, Opioid; Animals; Buprenorphine; Female; Nausea; Pain Management; Pain, Postoperative; Rats; Rats, Inbred F344

Guinea pigs (Cavia porcellus) are a frequently used species in research, often involving potentially painful procedures. Therefore, evidence-based recommendations regarding analgesia are critically needed to optimize their wellbeing. Our laboratory examined the efficacy of carprofen and extended-release (ER) buprenorphine, alone and as a multimodal combination, for relieving postsurgical pain in guinea pigs. Animals were assessed by using evoked (mechanical hypersensitivity), nonevoked (video ethogram, cageside ethogram, time-to-consumption test), and clinical (weight loss) measurements for 96 h during baseline, anesthesia-analgesia, and hysterectomy conditions. In addition, ER buprenorphine was evaluated pharmacologically. Guinea pigs treated with a single analgesic showed increased mechanical sensitivity for at least 96 h and indices of pain according to the video ethogram for as long as 8 h, compared with levels recorded during anesthesia-analgesia. In contrast, animals given both analgesics demonstrated increased mechanical sensitivity and behavioral evidence of pain for only 2 h after surgery compared with anesthesia-analgesia. The cageside ethogram and time-to-consumption tests failed to identify differences between conditions or treatment groups, highlighting the difficulty of identifying pain in guinea pigs without remote observation. Guinea pigs treated with multimodal analgesia or ER buprenorphine lost at least 10% of their baseline weights, whereas weight loss in carprofen animals was significantly lower (3%). Plasma levels for ER buprenorphine exceeded 0.9 ng/mL from 8 to 96 h after injection. Of the 3 analgesia regimens evaluated, multimodal analgesia provided the most effective pain control in guinea pigs. However the weight loss in the ER buprenorphine-treated animals may need to be considered during analgesia selection.

Topics: Acetaminophen; Analgesics, Opioid; Animals; Buprenorphine; Carbazoles; Drug Therapy, Combination; Female; Guinea Pigs; Hysterectomy; Pain Management; Pain Measurement; Pain, Postoperative; Specific Pathogen-Free Organisms

The local anesthetic bupivacaine is valuable for perioperative analgesia, but its use in the postoperative period is limited by its short duration of action. Here, we evaluated the application of a slow-release liposomal formulation of bupivacaine for postoperative analgesia. The aim was to assess whether liposomal bupivacaine effectively attenuates postoperative mechanical and thermal hypersensitivity in a rat model of incisional pain. Rats (n = 36) were randomly assigned to 1 of 5 treatment groups: saline, 1 mL/kg SC every 12 h for 2 d; buprenorphine HCl, 0.05 mg/kg SC every 12 h for 2 d (Bup HCl); 0.5% bupivacaine, 2 mg/kg SC local infiltration once (Bupi); liposomal bupivacaine, 1 mg/kg SC local infiltration once (Exp1); and liposomal bupivacaine, 6 mg/kg SC local infiltration once (Exp6). Mechanical and thermal hypersensitivity were evaluated daily on days -1, 0, 1, 2, 3, and 4. The saline group exhibited both hypersensitivities through all 4 evaluated postoperative days. Bup HCl attenuated mechanical hypersensitivity for 2 d and thermal hypersensitivity for 1 d. Bupi attenuated only thermal hypersensitivity for 4 d. Rats in the Exp1 group showed attenuation of both mechanical and thermal hypersensitivity for 4 d, and those in the Exp6 group had attenuation of mechanical hypersensitivity on day 0 and thermal hypersensitivity for 4 d. These data suggest that a single local infiltration of liposomal bupivacaine at a dose of 1 mg/kg SC effectively attenuates postoperative mechanical and thermal hypersensitivity for 4 d in a rat model of incisional pain.

Topics: Anesthetics, Local; Animals; Bupivacaine; Buprenorphine; Delayed-Action Preparations; Dose-Response Relationship, Drug; Liposomes; Male; Pain, Postoperative; Postoperative Period; Random Allocation; Rats

OBJECTIVE To compare analgesic and gastrointestinal effects of lidocaine and buprenorphine administered to rabbits undergoing ovariohysterectomy. ANIMALS Fourteen 12-month-old female New Zealand White rabbits. PROCEDURES Rabbits were assigned to 2 treatment groups (7 rabbits/group). One group received buprenorphine (0.06 mg/kg, IV, q 8 h for 2 days), and the other received lidocaine (continuous rate infusion [CRI] at 100 μg/kg/min for 2 days). Variables, including food and water consumption, fecal output, glucose and cortisol concentrations, and behaviors while in exercise pens, were recorded. RESULTS Rabbits receiving a lidocaine CRI had significantly higher gastrointestinal motility, food intake, and fecal output and significantly lower glucose concentrations, compared with results for rabbits receiving buprenorphine. Rabbits receiving lidocaine also had a higher number of normal behaviors (eg, sprawling, traveling, and frolicking) after surgery, compared with behaviors such as crouching and sitting that were seen more commonly in rabbits receiving buprenorphine. Both groups had significant weight loss after surgery. Pain scores did not differ significantly between treatment groups. Significant decreases in heart rate and respiratory rate were observed on the day of surgery, compared with values before and after surgery. Rabbits in the lidocaine group had significantly overall lower heart rates than did rabbits in the buprenorphine group. CONCLUSIONS AND CLINICAL RELEVANCE A CRI of lidocaine to rabbits provided better postoperative outcomes with respect to fecal output, food intake, and glucose concentrations. Thus, lidocaine appeared to be a suitable alternative to buprenorphine for alleviating postoperative pain with minimal risk of anorexia and gastrointestinal ileus.

Topics: Analgesics, Opioid; Anesthetics, Local; Animals; Buprenorphine; Female; Gastrointestinal Motility; Hysterectomy; Infusions, Intravenous; Lidocaine; Ovariectomy; Pain, Postoperative; Rabbits

Bupivacaine appears to have a duration of action longer than previously reported. Results of this study demonstrate that the addition of buprenorphrine may enhance the analgesic duration of effect for bupivacaine regional nerve blocks. In addition, the use of bupivacaine alone may have analgesia that exceeds 24 hours in many cases. Although not statistically significant based on sample size, 50% of dogs receiving the bupivacaine/buprenorphine regional anesthetic block demonstrated a decreased anesthetic requirement 48 hours postadministration when compared to 25% of dogs receiving the bupivacaine anesthetic. No adverse cardiorespiratory effects were noted secondary to either local anesthetic treatment. Use of bupivacaine may have analgesic effects extending greater than 24 hours (24-72) when used in regional anesthetic blocks in veterinary dental patients with acute dental pain. The addition of buprenorphine to bupivacaine may extend the duration of analgesia (48-96 h). The limited sample size, in addition to patient variability in response to medications, may account for the fact that no differences were detected between the treatments administered.

Topics: Anesthetics, Local; Animals; Bupivacaine; Buprenorphine; Dog Diseases; Dogs; Isoflurane; Nerve Block; Pain, Postoperative

Preoperative narcotic use has been associated with poor outcomes after total joint arthroplasty (TJA). The purpose of this study is to compare clinical outcomes of patients undergoing elective TJA while concurrently being treated with methadone or buprenorphine/naloxone for prior heroin addiction to a matched control group.. From an electronic medical record, we collected age, gender, body mass index, the presence of back pain, smoking status, history of alcohol abuse, preoperative use of a pain clinic, and use of antipsychotics, antidepressants, or systemic corticosteroids. Validated outcome measures including the 12-Item Short Form Survey, Knee Society Score (KSS), and Harris Hip Score were used to assess functional outcomes preoperatively and postoperatively. Perioperative data were retrospectively obtained from patient charts. Postoperative functional outcomes were prospectively collected at follow-up visits. Subjects were matched to 2:1 control group on the basis of procedure, sex, diagnosis, age (±5 years), and body mass index (±5 kg/m(2)). Average follow-up was 27.2 months.. Significant preoperative differences between the groups included mean morphine-equivalent requirements (997.1 mg for study group vs 24.8 mg for controls), 12-Item Short Form Survey Mental Component Scores (MCS-12; 37.8 for study group vs 49.0 for controls), smoking history, and antipsychotic medication use. Perioperative referral to inpatient Acute Pain Service and mean in-hospital morphine-equivalent narcotic usage (793 mg/24 h for study group vs 109 mg/24 h for controls) also significantly differed between groups. Knee range of motion differed significantly between the cohorts at 1 year (77.5 for study group vs 109.4); however, no significant difference in KSS pain (87.6 vs 84.4), KSS function (61 vs 80.9), Harris Hip Score (89.2 vs 85.3), MCS-12 (47.1 vs 52.9), or complications was observed.. Equivalent pain control and successful clinical outcome at 1 year can be achieved in patients who use methadone or buprenorphine/naloxone preoperatively.

Topics: Aged; Arthroplasty, Replacement; Buprenorphine; Cohort Studies; Female; Heroin Dependence; Humans; Male; Methadone; Middle Aged; Naloxone; Narcotic Antagonists; Narcotics; Pain Management; Pain, Postoperative; Prospective Studies; Registries; Retrospective Studies; Treatment Outcome

Postoperative analgesia in laboratory rats is complicated by the frequent handling associated with common analgesic dosing requirements. Here, we evaluated sustained-release buprenorphine (Bup-SR), sustained-release meloxicam (Melox-SR), and carprofen gel (CG) as refinements for postoperative analgesia. The aim of this study was to investigate whether postoperative administration of Bup-SR, Melox-SR, or CG effectively controls behavioral mechanical and thermal hypersensitivity in a rat model of incisional pain. Rats were randomly assigned to 1 of 5 treatment groups: saline, 1 mL/kg SC BID; buprenorphine HCl (Bup HCl), 0.05 mg/kg SC BID; Bup-SR, 1.2 mg/kg SC once; Melox-SR, 4 mg/kg SC once; and CG, 2 oz PO daily. Mechanical and thermal hypersensitivity were tested daily from day-1 through 4. Bup HCl and Bup-SR attenuated mechanical and thermal hypersensitivity on days 1 through 4. Melox-SR and CG attenuated mechanical hypersensitivity-but not thermal hypersensitivity-on days 1 through 4. Plasma concentrations, measured by using UPLC with mass spectrometry, were consistent between both buprenorphine formulations. Gross pathologic examination revealed no signs of toxicity in any group. These findings suggest that postoperative administration of Bup HCl and Bup-SR-but not Melox-SR or CG-effectively attenuates mechanical and thermal hypersensitivity in a rat model of incisional pain.

Topics: Analgesics; Animals; Body Weight; Buprenorphine; Carbazoles; Delayed-Action Preparations; Male; Meloxicam; Pain, Postoperative; Random Allocation; Rats; Rats, Sprague-Dawley; Thiazines; Thiazoles

Genetic factors are known to influence individual differences in pain and sensitivity to analgesics. Different genetic polymorphisms in opioid-metabolizing enzymes that can affect the analgesic response to opioids have been proposed. This study investigates a possible difference in the response to postoperative buprenorphine analgesia related to the presence of different isoforms (cytosine or thymine substitution at nucleotide 802) of UGT2B7 gene.. Transdermal buprenorphine was administered to 91 patients who underwent muscle-sparing thoracotomy. UGT2B7 polymorphism at locus C802T (His268Tyr) was detected using a PCR Taqman-based procedure. The severity of postoperative pain at rest and during coughing or deep inspiration was assessed by visual analog scale score after surgery. Hospital stay and perioperative opioid consumption were collected.. Genotype frequencies were 18.4% for UGT2B7*1/*1, 52.9% for UGT2B7*1/*2, and 28.7% for UGT2B7*2/*2. VAS pain scores at rest were statistically similar among the groups except at 24, 60, and 120 hours (UGT2B7*2/*2 genotype showing higher pain scores). Patients with the UGT2B7*2/*2 genotype showed higher VAS scores triggered by coughing after the 48 hours (P < 0.05). In addition, patients with this genotype reported a higher prevalence of severe pain after 48 postoperative hours (P < 0.05). Thirty-eight percent of patients carrying genotype UGT2B7*2/*2 experienced severe pain in a final survey vs. 17% in the group with UGT2B7*1/*1 (P = 0.36).. The presence of the SNP 802C>T UGT2B7 (UGT2B7*2/*2) is associated with a worse analgesic response to transdermal buprenorphine in the postoperative period of thoracic surgery.

Topics: Administration, Cutaneous; Adult; Aged; Analgesics, Opioid; Buprenorphine; Female; Genotype; Glucuronosyltransferase; Humans; Length of Stay; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Polymerase Chain Reaction; Polymorphism, Genetic; Severity of Illness Index; Thoracotomy

Topics: Analgesics; Benchmarking; Buprenorphine; Clonidine; Dexamethasone; Drug Therapy, Combination; Humans; Midazolam; Nerve Block; Pain, Postoperative

Topics: Analgesics; Buprenorphine; Clonidine; Dexamethasone; Drug Therapy, Combination; Humans; Midazolam; Nerve Block; Pain, Postoperative

Nonevoked spontaneous pain is most problematic for postoperative patients. Physicians assess this form of pain using the human visual analog scale or verbal numeric rating scale. Recent studies have proposed that spontaneous foot-lifting (SFL) behaviors are an expression of spontaneous pain in animals after spinal nerve injury or adjuvant-induced inflammation. In the current study, we characterize SFL behaviors in a rat model of acute postoperative pain, which includes comparisons with evoked behaviors to analgesic treatments.. SFL was manually recorded over four 5-minute periods with 10-minute intervals between each testing session. Paw-withdrawal thresholds were subsequently measured with an electronic von Frey esthesiometer. To evaluate the effects of age, rats were tested in different age groups: 2, 7, and >26 months. The effects of buprenorphine and morphine were tested in a separate group of animals, which received intraperitoneal injections of saline, morphine (0.01, 0.1, 1, or 2 mg/kg), or buprenorphine (0.001, 0.01, or 0.1 mg/kg) before testing.. SFL behaviors peaked at 3 hours after incision and significantly recovered by the 3rd or 4th postoperative day (P < 0.0001). The presentation of these behaviors did not significantly vary with animal age (2, 7, and >26 months old; P = 0.30). SFL behaviors, with the exception of rapid SFL at 3 hours after incision, did not show significant correlation with paw-withdrawal threshold behaviors. The median effective dose of buprenorphine for reversal of mechanical hyperalgesia (0.0452 mg/kg; 95% CI, 0.0259-0.0787) was significantly larger than for reversing rapid (0.0027 mg/kg; 95% CI, 0.0009-0.0083; P < 0.0001) and prolonged (0.0004 mg/kg, 95% CI, 0.0000, 0.0035; P = 0.001) SFL at 3 hours after incision. Similarly, the median effective dose of morphine for reversal of mechanical hypersensitivity behaviors (2.901 mg/kg; 95% CI, 1.132-7.436) was larger than for SFL count (0.4044 mg/kg; 95% CI, 0.1048-1.561; P = 0.0103) and SFL duration (0.0309 mg/kg; 95% CI, 0.0095-0.0998; P < 0.0001) at 3 hours after incision.. The present study demonstrates that a hindpaw plantar incision induces SFL behaviors in rats and that these behaviors have higher bioassay sensitivity to analgesic interventions with morphine and buprenorphine compared with mechanically evoked behaviors.

Topics: Acute Pain; Aging; Analgesics, Opioid; Animals; Behavior, Animal; Buprenorphine; Hyperalgesia; Morphine; Pain, Postoperative; Physical Stimulation; Rats; Rats, Inbred F344; Rats, Sprague-Dawley; Species Specificity

Pain management in laboratory animals is generally accomplished by using opioids and NSAIDs. However, opioid use is hindered by controlled substance requirements and a relatively short duration of action. In this study, we compared the analgesic efficacy of firocoxib (a cyclooxygenase-2-selective NSAID) with that of buprenorphine in the mouse model of plantar incisional pain by objective measurement of mechanical allodynia and thermal hyperalgesia using von Frey and Hargreaves equipment, respectively. Our experimental design included 5 treatment groups: firocoxib at 10 mg/kg IP every 24 h (F10 group); firocoxib at 20 mg/kg IP every 24 h (F20); buprenorphine at 0.2 mg/kg SC every 8 h; intraperitoneal normal saline every 24 h; and sham group (anesthesia, no incision) treated with firocoxib at 20 mg/kg IP every 24 h (sham+F20). All mice underwent nociceptive assays at 24 h before and 4, 24, 48, and 72 h after surgery. Buprenorphine alleviated allodynia at all time points after incision. The F10 treatment alleviated allodynia at 4, 24, and 48 h, whereas F20 alleviated allodynia at 24, 48, and 72 h. None of the treatments alleviated thermal hyperalgesia at 4h. Except for F10 and buprenorphine at 24 h, all treatments alleviated thermal hyperalgesia at 24, 48, and 72 h. No significant differences were noted between the 2 doses of firocoxib and buprenorphine regarding mechanical allodynia and thermal hyperalgesia at all time points. In conclusion, the analgesic efficacy of firocoxib is comparable to that of buprenorphine in this mouse pain model.

Topics: 4-Butyrolactone; Analgesics, Opioid; Animals; Buprenorphine; Cyclooxygenase 2 Inhibitors; Female; Hyperalgesia; Mice; Mice, Inbred C57BL; Pain, Postoperative; Random Allocation; Rodent Diseases; Specific Pathogen-Free Organisms; Sulfones

Colon anastomotic leakage remains a serious and common surgical complication. Animal models are valuable to determine the pathophysiological mechanisms and to evaluate possible methods of prevention. The aim of this study was to develop an optimal model of clinical colon anastomotic leakage in a technically insufficient anastomosis in the mouse.. A total of 110 mice were used in three pilot studies (1-3) and two experiments (A, B). Due to the high complication rates, the analgesic regimen and surgical techniques were changed throughout the pilot studies/experiments. In the final successful experiment (B), eight and four absorbable sutures were used in the control and intervention anastomoses, respectively, and buprenorphine in chocolate spread was used for pain treatment.. In the final model (experiment B), significantly more animals in the intervention group had clinical anastomotic leakage compared with controls (40 vs. 0 %, p = 0.003). The weight loss was greater and the wellness score was also lower in these animals (p < 0.001). The breaking strength of the anastomoses was not significantly different between the control group [0.55 N ± 0.09] and intervention group [0.49 N ± 0.15] (p = 0.091).. This mouse model closely mimics clinical colon anastomotic leakage in humans. The model is of high clinical relevance, since anastomotic leakage has a similar cause, incidence and manifestations in humans.

Topics: Analgesics, Opioid; Anastomotic Leak; Animals; Buprenorphine; Colonic Diseases; Disease Models, Animal; Male; Mice; Mice, Inbred BALB C; Pain, Postoperative; Pilot Projects; Polyglactin 910; Polypropylenes; Sutures

We review clinical care issues that are related to illicit and therapeutic opioid use among pregnant women and women in the postpartum period and outline the major responsibilities of obstetrics providers who care for these patients during the antepartum, intrapartum, and postpartum periods. Selected patient treatment issues are highlighted, and case examples are provided. Securing a strong rapport and trust with these patients is crucial for success in delivering high-quality obstetric care and in coordinating services with other specialists as needed. Obstetrics providers have an ethical obligation to screen, assess, and provide brief interventions and referral to specialized treatment for patients with drug use disorders. Opioid-dependent pregnant women often can be treated effectively with methadone or buprenorphine. These medications are classified as pregnancy category C medications by the Food and Drug Administration, and their use in the treatment of opioid-dependent pregnant patients should not be considered "off-label." Except in rare special circumstances, medication-assisted withdrawal during pregnancy should be discouraged because of a high relapse rate. Acute pain management in this population deserves special consideration because patients who use opioids can be hypersensitive to pain and because the use of mixed opioid-agonist/antagonists can precipitate opioid withdrawal. In the absence of other indications, pregnant women who use opioids do not require more intense medical care than other pregnant patients to ensure adequate treatment and the best possible outcomes. Together with specialists in pain and addiction medicine, obstetricians can coordinate comprehensive care for pregnant women who use opioids and women who use opioids in the postpartum period.

Topics: Analgesics, Opioid; Buprenorphine; Confidentiality; Dose-Response Relationship, Drug; Emergency Service, Hospital; Female; Humans; Labor Pain; Labor, Obstetric; Mental Disorders; Methadone; Narcotic Antagonists; Opiate Substitution Treatment; Opioid-Related Disorders; Pain, Postoperative; Physician-Patient Relations; Postnatal Care; Pregnancy; Pregnancy Complications; Prenatal Care; Referral and Consultation; Triage

The aim of this retrospective study was to compare buprenorphine and tramadol, in order to assess their different efficacy in prolonging postoperative analgesia and their associated side effects when used as perineural adjuvants with a local anesthetic.. The clinical records of 161 consecutive ASA 1-2 adult patients scheduled for arthroscopic rotator cuff repair and fulfilling the inclusion/exclusion criteria were reviewed retrospectively. The anaesthesia was performed using the middle interscalene block (MIB). The 161 patients were divided into three groups (A, B, T) according to their utilization of buprenorphine (B), tramadol (T) or neither of the latter (A) as perineural adjuvants: group A (54 patients) - levobupivacaine 0.75%, 0.4 mL/kg; group B (56 patients) - levobupivacaine 0.75%, 0.4 mL/kg + 0.15 mg buprenorphine; group T (51 patients) - levobupivacaine 0.75%, 0.4 mL/kg + 100 mg tramadol.. The results showed that the group treated with buprenorphine benefited from a longer post-operative analgesia than that treated with local anesthetic alone (P<0.0001). Otherwise, a less evident not statistically significant (P=0.4825) difference turned out between the group treated with the anesthetic alone and the group treated with tramadol as adjuvant. No difference turned out to be between the local anesthetic alone treatment and the tramadol-local anesthetic one (P=0.4825; HR=0.863, 95% CI 0.574-1.299); on the contrary, a significant difference was demonstrated between the buprenophine-local anesthetic group and the local anesthetic alone one (P<0.0001; HR=0.330, 95% CI 0.216-0.530) CONCLUSION: Both buprenorphine and tramadol are effective as perineural adjuvants used in order to prolong the postoperative analgesia, buprenorphine proving more efficacious for this purpose than tramadol.

Topics: Adult; Aged; Analgesics, Opioid; Anesthetics, Local; Arthroscopy; Buprenorphine; Female; Humans; Male; Middle Aged; Nerve Block; Pain, Postoperative; Retrospective Studies; Rotator Cuff; Tramadol

Effective management of postoperative pain is an essential component of the care and welfare of laboratory animals. A sustained-release formulation of buprenorphine (Bup-SR) has recently been introduced to the veterinary market and has been reported to provide analgesia for as long as 72 h. Using evoked mechanical and thermal hypersensitivity tests, we here evaluated the antinociceptive effects of Bup-SR in a model of incisional pain in rats. Paw withdrawal responses were obtained before and 1 through 4 d after surgery. Rats are assigned to receive Bup-SR (0.3, 1.2, or 4.5 mg/kg SC once) or buprenorphine HCl (Bup HCl, 0.05 mg/kg SC twice daily for 3 d). Responses to mechanical and thermal stimuli in the 1.2 and 4.5 Bup-SR groups did not differ from those of rats in the Bup HCl group. Thermal latency on day 3 in rats that received 0.3 mg/kg Bup-SR was significantly different from baseline, indicating that this dose effectively decreased thermal hypersensitivity for at least 48 h. Marked sedation occurred in rats in the 4.5 Bup-SR group. Our findings indicate that Bup-SR at 0.3 or 1.2 mg/kg SC is effective in minimizing hypersensitivity with minimal sedation for at least 48 h (thermal hypersensitivity) and 72 h, respectively, in the incisional pain model in rats.

Topics: Analgesics, Opioid; Animal Welfare; Animals; Buprenorphine; Delayed-Action Preparations; Disease Models, Animal; Male; Pain Management; Pain Measurement; Pain, Postoperative; Random Allocation; Rats; Rats, Sprague-Dawley

Topics: Administration, Oral; Aged; Analgesics, Opioid; Arthroplasty, Replacement, Hip; Buprenorphine; Chronic Pain; Dose-Response Relationship, Drug; Female; Humans; Iatrogenic Disease; Injections, Intramuscular; Long-Term Care; Meperidine; Opioid-Related Disorders; Pain, Postoperative; Patient Admission

Topics: Analgesia; Animals; Body Temperature; Buprenorphine; Hepatectomy; Mice; Pain, Postoperative

Buprenorphine is a semisynthetic opioid with both agonist and antagonist activity at the opioid receptor. Currently, buprenorphine is commonly available in sublingual preparations combined with naloxone (e.g., Suboxone®, Subutex®). There has been increased use of buprenorphine derivatives in the areas of substance addiction and chronic pain. Nevertheless, there is limited and conflicting information in the literature pertaining to the optimal management of buprenorphine-stabilized patients presenting for surgery. We present our experience with a chronic pain patient on buprenorphine presenting for thoracic surgery.. A 47-yr-old female with a history of a Clagett window procedure for pulmonary aspergillosis and subsequent chronic pain presented to our institute for a window closure procedure. Preoperatively, her pain regimen included Suboxone 16 mg bid, which was continued perioperatively. Postoperatively, her course was complicated by suboptimal pain at the surgical site requiring in excess of 70 mg/24 hr of intravenous hydromorphone. Liberal addition of long-acting oral opioids was ineffective in improving pain management. Eventually, concern was raised regarding opioid receptor blockade by her long-acting Suboxone, and the decision was made to taper her Suboxone. Following this, her pain control improved dramatically and her opioid requirements were markedly reduced. By discharge, her Suboxone was discontinued and she was managed on oral hydromorphone.. In a chronic pain patient continued on Suboxone perioperatively, significant improvement in control of postoperative pain was observed following tapered doses, and eventually her use of Suboxone was discontinued. This case highlights the potential for opioid receptor blockade by Suboxone, which can interfere with acute pain management.

Topics: Buprenorphine; Buprenorphine, Naloxone Drug Combination; Chronic Pain; Female; Humans; Middle Aged; Naloxone; Pain, Postoperative; Pulmonary Aspergillosis; Thoracic Surgical Procedures

The goal of the current study was to compare the efficacy, adverse effects, and plasma buprenorphine concentrations of sustained-release buprenorphine (SRB) and buprenorphine after subcutaneous administration in dogs undergoing ovariohysterectomy. In a prospective, randomized, blinded design, 20 healthy adult female Beagle dogs underwent routine ovariohysterectomy and received multimodal analgesia consisting of meloxicam and one of two buprenorphine formulations. Dogs were randomly assigned to receive either SRB (0.2 mg/kg SC, once) or buprenorphine (0.02 mg/kg SC every 12 h for 3 d). Blinded observers assessed all dogs by using sedation scores, pain scores, temperature, HR, RR, and general wellbeing. Dogs were provided rescue analgesia with 0.02 mg/kg buprenorphine SC if the postoperative pain score exceeded a prede- termined threshold. Blood samples were collected, and mass spectrometry was used to determine plasma buprenorphine concentrations. Data were analyzed with a linear mixed model and Tukey-Kramer multiple comparison. Age, body weight, anesthetic duration, surgical duration, sevoflurane concentration, and cardiorespiratory variables did not differ significantly between groups. Dogs in both formulation groups had comparable postoperative sedation and pain scores. One dog from each formulation group had breakthrough pain requiring rescue analgesia. Plasma buprenorphine concentrations remained above a hypothesized therapeutic concentration of 0.6 ng/mL for 136.0 ± 11.3 and 10.67 ± 0.84 h for SRB and buprenorphine, respectively. Based on the results of this study, multimodal analgesic regimens consisting of meloxicam and either buprenorphine or SRB are equally efficacious in managing pain associated with an ovariohysterectomy and show comparable side effects.

Topics: Analgesics; Animals; Buprenorphine; Cytokines; Delayed-Action Preparations; Dogs; Female; Humans; Hysterectomy; Meloxicam; Ovariectomy; Pain Measurement; Pain, Postoperative; Prospective Studies; Thiazines; Thiazoles; Veins

The prescribing of opioid pain medication has increased markedly in recent years, with strong opioid dispensing increasing 18-fold in Tayside, Scotland since 1995. Despite this, little data is available to quantify the problem of opioid pain medication dependence (OPD) and until recently there was little guidance on best-practice treatment. We report the case of a young mother prescribed dihydrocodeine for postoperative pain relief who became opioid dependent. When her prescription was stopped without support, she briefly used heroin to overcome her withdrawal. After re-exposure to dihydrocodeine following surgery 9 years later and treatment with methadone for dependency, she was transferred to buprenorphine/naloxone. In our clinical experience and in agreement with Department of Health and Royal College of General Practitioner guidance, buprenorphine/naloxone is the preferred opioid substitution treatment for OPD. Our patient remains within her treatment programme and has returned to work on buprenorphine 16 mg/naloxone 4 mg in conjunction with social and psychological support.

Topics: Adult; Analgesics, Opioid; Buprenorphine; Codeine; Disease Management; Female; Heroin; Heroin Dependence; Humans; Methadone; Naloxone; Opiate Substitution Treatment; Opioid-Related Disorders; Pain, Postoperative; Substance Withdrawal Syndrome; Young Adult

The number of patients in buprenorphine opioid substitution therapy (BOST) or methadone opioid substitution therapy (MOST) programs is increasing. If these patients require surgery, it is generally agreed that methadone should be continued perioperatively. While some also recommend that buprenorphine is continued, concerns that it may limit the analgesic effectiveness of full mu-opioid agonists have led others to suggest that it should cease before surgery. However, no good evidence exists for either course of action. Therefore, we undertook a retrospective cohort study comparing pain relief and opioid requirements in the first 24 hours after surgery in 22 BOST and 29 MOST patients prescribed patient-controlled analgesia. There were no significant differences in pain scores (rest and movement), incidence of nausea or vomiting requiring treatment, or sedation between the BOST and MOST patient groups overall, or between those patients within each of these groups who had and had not received their methadone or buprenorphine the day after surgery. There were also no significant differences in patient-controlled analgesia requirements between BOST and MOST patient groups overall, or between patients who did or did not receive MOST on the day after surgery. BOST patients who were not given their usual buprenorphine the day after surgery used significantly more patient-controlled analgesia opioid (P=0.02) compared with those who had received their dose. These results confirm that continuation of buprenorphine perioperatively is appropriate.

Topics: Adult; Analgesia, Patient-Controlled; Analgesics, Opioid; Buprenorphine; Cohort Studies; Female; Humans; Male; Methadone; Middle Aged; Pain, Postoperative; Retrospective Studies

Topics: Adult; Buprenorphine; Female; Humans; Male; Naltrexone; Narcotic Antagonists; Opioid-Related Disorders; Pain Management; Pain, Postoperative

Despite the increasing use of rabbits as companion animals and models for biomedical research, rabbits have not been extensively studied to identify an efficacious postsurgical analgesic that does not cause systemic complications. The synergy of NSAID and systemic opioids is well-documented, and their combined use reduces the amount of either drug required for adequate analgesia. We measured fecal corticosterone metabolites (FCM) in rabbits after a minimally invasive vascular cut-down procedure. Rabbits received buprenorphine (0.03 mg/kg SC every 12 h for 3 d), meloxicam (0.2 mg/kg SC every 24 h for 3 d), buprenorphine-meloxicam (0.01 mg/kg-0.1 mg/kg SC every 24 h for 3 d), or a single dose of 0.5% bupivacaine (0.5 mL) infused locally at the incision site. By day 3 after surgery, buprenorphine, meloxicam, and bupivacaine groups showed elevated FCM levels, which continued to rise until day 7 and then gradually returned to baseline by day 28. In the buprenorphine-meloxicam group, FCM was relatively unchanged until day 3, when treatment was discontinued, and then began to rise. Rabbits in the buprenorphine-meloxicam group gained more weight over the 28-d study than did those in the other 3 treatment groups. This study shows that in rabbits low-dose buprenorphine administered with meloxicam effectively mitigates the FCM response that develops after surgery without the adverse effects associated with higher doses.

Topics: Analgesia; Analgesics, Opioid; Anesthetics, Local; Animals; Anti-Inflammatory Agents, Non-Steroidal; Body Weight; Bupivacaine; Buprenorphine; Corticosterone; Drug Therapy, Combination; Feces; Glucocorticoids; Male; Meloxicam; Minimally Invasive Surgical Procedures; Pain, Postoperative; Rabbits; Thiazines; Thiazoles

Establishing effective cage-side pain assessment methods is essential if post-surgical pain is to be controlled effectively in laboratory animals. Changes to overall activity levels are the most common methods of assessment, but may not be the most appropriate for establishing the analgesic properties of drugs, especially in mice, due their high activity levels. Use of drugs that can affect activity (e.g. opioids) is also a problem. The relative merits of both manual and automated behaviour data collection methods was determined in two inbred mouse strains undergoing vasectomy following treatment with one of 2 buprenorphine dose rates. Body weights and the effects of surgery and buprenorphine on faecal corticosterone were also measured. Surgery caused abnormal behaviour and reduced activity levels, but high dose buprenorphine caused such large-scale increases in activity in controls that we could not establish analgesic effects in surgery groups. Only pain-specific behaviour scoring using the manual approach was effective in showing 0.05 mg/kg buprenorphine alleviated post-vasectomy pain. The C57 mice also responded better to buprenorphine than C3H mice, indicating they were either less painful, or more responsive to its analgesic effects. C3H mice were more susceptible to the confounding effects of buprenorphine irrespective of whether data were collected manually or via the automated approach. Faecal corticosterone levels, although variable, were higher in untreated surgery mice than in control groups, also indicating the presence of pain or distress. Pain-specific scoring was superior to activity monitoring for assessing the analgesic properties of buprenorphine in vasectomised mice. Buprenorphine (0.01 mg/kg), in these strains of male mice, for this procedure, provided inadequate analgesia and although 0.05 mg/kg was more effective, not completely so. The findings support the recommendation that analgesic dose rates should be adjusted in relation to the potential severity of the surgical procedure, the mouse strain, and the individual animals' response.

Topics: Animals; Behavior, Animal; Buprenorphine; Corticosterone; Data Collection; Feces; Male; Mice; Pain, Postoperative; Species Specificity; Vasectomy

Postoperative pain management in animals is complicated greatly by the inability to recognize pain. As a result, the choice of analgesics and their doses has been based on extrapolation from greatly differing pain models or the use of measures with unclear relevance to pain. We recently developed the Mouse Grimace Scale (MGS), a facial-expression-based pain coding system adapted directly from scales used in nonverbal human populations. The MGS has shown to be a reliable, highly accurate measure of spontaneous pain of moderate duration, and therefore is particularly useful in the quantification of postoperative pain. In the present study, we quantified the relative intensity and duration of postoperative pain after a sham ventral ovariectomy (laparotomy) in outbred mice. In addition, we compiled dose-response data for 4 commonly used analgesics: buprenorphine, carprofen, ketoprofen, and acetaminophen. We found that postoperative pain in mice, as defined by facial grimacing, lasts for 36 to 48 h, and appears to show relative exacerbation during the early dark (active) photophase. We find that buprenorphine was highly effective in inhibiting postoperative pain-induced facial grimacing in mice at doses equal to or lower than current recommendations, that carprofen and ketoprofen are effective only at doses markedly higher than those currently recommended, and that acetaminophen was ineffective at any dose used. We suggest the revision of practices for postoperative pain management in mice in light of these findings.

Topics: Acetaminophen; Analgesics; Animals; Animals, Laboratory; Buprenorphine; Carbazoles; Dose-Response Relationship, Drug; Facial Expression; Ketoprofen; Mice; Pain Measurement; Pain, Postoperative; Research Design; Time Factors; Video Recording

Buprenorphine/naloxone is used for the treatment of opioid dependence. In the following case, a potential use for the medication combination is explored in the arena of transplant surgery. Psychiatry was consulted for a 29-year-old woman with iatrogenic opioid dependence after bilateral ventricular assist device placement for congenital cardiomyopathy. Her ejection fraction was less than 15% and she was considered a poor candidate for transplant due to drug-seeking behaviors. We transitioned her onto buprenorphine/naloxone to prevent abuse and control symptoms, qualifying her for cardiac transplant. After transplant, we coordinated care with cardiothoracic surgeons to restart buprenorphine/naloxone, and the patient has been stable for 8 months.

Topics: Adult; Buprenorphine; Cardiomyopathies; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Heart Transplantation; Heart-Assist Devices; Humans; Iatrogenic Disease; Naloxone; Narcotics; Opiate Substitution Treatment; Opioid-Related Disorders; Pain, Postoperative; Substance Withdrawal Syndrome

The clinical efficacy of a 70 microg/h transdermal buprenorphine patch and of 20 microg/kg of buprenorphine administered subcutaneously (SC) for the relief of post-operative pain was determined in 24 healthy female dogs undergoing elective ovariohysterectomy (OHE). Dogs were randomly assigned to three groups: (1) a control group that received no analgesics, (2) a BSC group that received buprenorphine SC (20 microg/kg), and (3) a BP group that received buprenorphine by a 70 microg/h transdermal patch. Dogs were scored for signs of pain at 0, 2, 4, 6, 8, 10, 14, 20, 26, 32 and 38 h after extubation using the Numerical Rating Scale (NRS) and a modified University of Melbourne Pain Scale (UMPS). Mean NRS and UMPS scores for dogs in the BSC group (2.56 ± 0.23 and 3.05 ± 0.27, respectively) and the BP group (2.02 ± 0.24 and 2.67 ± 0.23, respectively) were significantly lower (P<0.05) compared with dogs in the control group (5.42 ± 0.38 and 7.89 ± 0.44, respectively), whereas differences between the two buprenorphine treatment groups were not significant. The results indicated that the analgesia produced by the 70 microg/h patch was similar to that induced by SC administration of 20 microg/kg of buprenorphine in dogs undergoing OHE, suggesting that the transdermal buprenorphine patch may be a useful alternative for pain management in dogs.

Topics: Administration, Cutaneous; Analgesia; Analgesics, Opioid; Animals; Buprenorphine; Dogs; Female; Hysterectomy; Injections, Subcutaneous; Ovariectomy; Pain Measurement; Pain, Postoperative; Treatment Outcome

Glossopharyngeal neuralgia is a rare condition and the origin is mostly idiopathic. Causes of symptomatic glossopharyngeal neuralgia can be tumors, infarction or trauma. We report the case of a 28-year-old patient who developed glossopharyngeal neuralgia after resection of a glossopharyngeal schwannoma, which is an extremely rare tumor. Treatment consisted of orally administered pregabalin and a series of injections of buprenorphine in the superior cervical ganglion (ganglionic local opioid application/analgesia, GLOA) which led to a substantial decrease in the frequency of pain attacks. This improvement was maintained at 1-year follow-up. This is the first report of development of glossopharyngeal neuralgia after resection of a glossopharyngeal schwannoma.

Topics: Administration, Oral; Adult; Analgesics; Analgesics, Opioid; Autonomic Nerve Block; Buprenorphine; Chronic Disease; Female; gamma-Aminobutyric Acid; Glossopharyngeal Nerve; Glossopharyngeal Nerve Diseases; Humans; Injections; Magnetic Resonance Imaging; Neurilemmoma; Pain Measurement; Pain, Postoperative; Pregabalin; Superior Cervical Ganglion

C57BL/6NCrl male mice (n = 60; age, 6 to 7 wk) underwent partial hepatectomy or no surgery and were given 1 of 3 analgesics pre- and postoperatively. Food and water consumption, body weight, running wheel activity, locomotor activity, and serum corticosterone concentrations were measured before and after surgery. Mice that were surgically manipulated weighed significantly less on days 1 through 3 after surgery than did mice not manipulated surgically. On the day of surgery, the surgery groups consumed significantly less feed (-1.5±0.35 g) than did nonsurgery groups. There were no differences in water consumption on any day between surgery and nonsurgery groups or among the 3 analgesic groups. For running wheel activity, significant decreases in the surgery groups were seen at day 1 after surgery compared with baseline. Surgery groups that received buprenorphine and meloxicam returned to baseline activity levels on day 2 after surgery. Open-field testing revealed no significant differences in locomotor activity in any groups; however, posttreatment locomotor activity in the buprenorphine nonsurgery group was increased compared with baseline, and posttreatment locomotor activity in the flunixin meglumine surgery group was decreased compared with baseline. Serum corticosterone concentrations were within normal limits regardless of treatment in all groups. Comparison of the overall results indicated that meloxicam and buprenorphine, at the dose given, appear to be suitable postoperative analgesics for partial hepatectomy in mice. Flunixin meglumine at the given dosage (2.5 mg/kg) may not provide adequate analgesia for partial hepatectomy.

Topics: Analgesics, Opioid; Animals; Anti-Inflammatory Agents, Non-Steroidal; Behavior, Animal; Buprenorphine; Clonixin; Drinking; Eating; Hepatectomy; Male; Meloxicam; Mice; Mice, Inbred C57BL; Models, Animal; Pain, Postoperative; Postoperative Period; Thiazines; Thiazoles

Postoperative pain management in laboratory animals relies heavily on a limited number of drug classes, such as opioids and nonsteroidal antiinflammatory drugs. Here we evaluated the effects of saline, tramadol, tramadol with gabapentin, and buprenorphine (n = 6 per group) in a rat model of incisional pain by examining thermal hyperalgesia and weight-bearing daily for 6 d after surgery. All drugs were administered preemptively and continued for 2 consecutive days after surgery. Rats treated with saline or with tramadol only showed thermal hyperalgesia on days 1 through 4 and 1 through 3 after surgery, respectively. In contrast, buprenorphine-treated rats showed no thermal hyperalgesia on days 1 and 2 after surgery, and rats given tramadol with gabapentin showed reduced thermal hyperalgesia on days 2 and 4. For tests of weight-bearing, rats treated with saline or with tramadol only showed significantly less ipsilateral weight-bearing on day 1 after surgery, whereas rats given either buprenorphine or tramadol with gabapentin showed no significant change in ipsilateral weight-bearing after surgery. These data suggest that tramadol alone provides insufficient analgesia in this model of incisional pain; buprenorphine and, to a lesser extent, tramadol with gabapentin provide relief of thermal hyperalgesia and normalize weight-bearing.

Topics: Amines; Analgesics; Animals; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Hyperalgesia; Male; Models, Animal; Pain, Postoperative; Postoperative Period; Rats; Rats, Sprague-Dawley; Tramadol; Weight-Bearing

Preventing and minimizing pain in laboratory animals is a basic tenet of biomedical research and is warranted for ethical, legal, and scientific reasons. Postoperative analgesia is an important facet of pain management. A sustained-release formulation of buprenorphine was tested in rats for analgesic efficacy and plasma concentration over a 72-h time period. Rats were injected subcutaneously with either 1.2 mg/kg sustained-release formulation (Bup-SR), 0.2 mL/kg buprenorphine HCl (Bup-HCl), or an equivalent volume of sustained-release vehicle and tested in a thermal nociception model or a surgical postoperative pain model. In both models, Bup-SR showed evidence of providing analgesia for 2 to 3 d. Thermal latency response in rats that received the sustained-release formulation increased 28.4% and 15.6% compared with baseline values on days 1 and 2, respectively. Rats with a unicortical tibial defect and treated with Bup-SR showed similar willingness to bear weight on the hindlimbs as did negative-control animals (no surgery), demonstrated by counting vertical raises; rats treated with Bup-HCl had significantly fewer vertical raises than did control rats for 5 d after surgery. Plasma concentrations of buprenorphine remained over 1 ng/mL for 72 h after a single dose of Bup-SR. Taken together, the results indicate that this formulation of buprenorphine may be a viable option for treating postsurgical pain in laboratory rats.

Topics: Analgesia; Analgesics, Opioid; Animals; Buprenorphine; Delayed-Action Preparations; Drug Combinations; Injections, Subcutaneous; Male; Pain Measurement; Pain, Postoperative; Rats; Rats, Sprague-Dawley

Minimizing the pain or discomfort of research animals through refinement of surgical techniques is inherent in the humane use of animals in investigative studies. The current approach for intraperitoneal implantation of radiotelemetry devices in mice is a ventral midline incision. An optional surgical approach is a flank incision. We used multidimensional analysis to compare midline and flank approaches for implantation of radiotelemetry devices in regard to time of surgery, activity, temperature, food intake, gel intake, body weight, and vitality scores. A third group was used to evaluate the effects of buprenorphine in healthy mice. The study demonstrated positive benefits related to the flank approach, including quicker surgery times, improved activity levels, more stable temperature homeostasis, smaller losses in body weight, and quicker return to presurgical baseline levels of food intake. In addition, direct effects of buprenorphine included decreases in food intake and body weight, with the effects on body weight lasting approximately 8 d after treatment. Collectively, these results suggest that implantation of intraperitoneal radiotelemetry devices by using a flank approach is beneficial to mice.

Topics: Analgesics, Opioid; Animals; Body Temperature; Body Weight; Buprenorphine; Drinking; Eating; Laboratory Animal Science; Mice; Multivariate Analysis; Pain, Postoperative; Postoperative Period; Recovery of Function; Surgery, Veterinary; Telemetry

It is well known that buprenorphine compete with remifentanil for receptor binding. I have examined the effect of buprenorphine administration on postoperative analgesia following remifentanil-based anesthesia.. In this study, I enrolled 30 patients who had undergone open reduction and internal fixation for fractures at the extremities under general anesthesia. Anesthesia was maintained with continuous infusion of remifentanil, and buprenorphine was administered at the end of surgery. Postoperative pain and side effects were evaluated in all patients.. Seventeen patients (57%) required additional analgesic treatment within 1 hour of initial administration of buprenorphine. Buprenorphine therapy in patients who had undergone lower limb surgery was not as effective as that in patients who had undergone upper limb surgery. Incidence of nausea and vomiting in the study population was high(37%).. Buprenorphine is effective to some degree as a postoperative analgesic following remifentanil-based anesthesia, but is not sufficient in cases of severe postoperative pain.

Topics: Adult; Aged; Analgesics, Opioid; Anesthesia, General; Buprenorphine; Female; Fracture Fixation, Internal; Humans; Lower Extremity; Male; Middle Aged; Pain, Postoperative; Piperidines; Remifentanil; Upper Extremity

We evaluated the effectiveness of low-dose patient-controlled epidural analgesia (PCEA) in the patients undergoing laparoscopic gynecological surgery, and investigated the difference of postoperative pain between patients for laparoscopic ovarian cystectomy and those for myomectomy.. Thirteen patients (ASA PS 1 or 2), scheduled for laparoscopic surgery, were enrolled in this study. They were divided into two groups of ovarian cystectomy (group C, n=17) and myomectomy (group M, n=13). After administering epidural bolus of 0.2% ropivacaine 6 ml, droperidol 2.5 mg, and buprenorphine hydrochloride 0.1 mg, PCEA was started: 1 ml x hr(-1) background infusion; 0.2% ropivacaine 54 ml, droperidol 5 mg, and buprenorphine hydrochloride 0.3 mg; 1 ml epidural bolus with a 30-minute lockout interval. We evaluated postoperative pain using visual analogue scale (VAS) at rest and on movement, adverse effects such as respiratory and cardiovascular depression, nausea and vomiting for 48 hours after surgery.. VAS at rest with group M was significantly higher than that of group C (11 +/- 2 vs. 6 +/- 2, P=0.048), and VAS on movement of group M was also higher than that of group C (25 +/- 3 vs. 18 +/- 2, P=0.023): however, we found good analgesic effect of less than VAS 3 in both groups. Severe adverse effects were not observed.. These findings suggest that low dose PCEA is effective for patients who undergo laparoscopic gynecological surgery.

Topics: Adult; Amides; Analgesia, Epidural; Analgesia, Patient-Controlled; Buprenorphine; Droperidol; Endometriosis; Female; Gynecologic Surgical Procedures; Humans; Laparoscopy; Ovarian Cysts; Pain, Postoperative; Ropivacaine

Topics: Analgesics; Animals; Buprenorphine; Dog Diseases; Female; Hysterectomy; Ovariectomy; Pain, Postoperative

It has become a popular practice to add opioids to spinal solutions to enhance and prolong intraoperative and postoperative analgesia in cesarean section. Morphine is the opioid most widely used for this purpose, but there are few reports about intrathecal buprenorphine. We evaluated the postoperative analgesic effect of intrathecal buprenorphine compared with intrathecal morphine after cesarean section.. We retrospectively compared group B (n = 20) receiving tetracaine 10mg plus intrathecal buprenorphine 0.05 mg with group M (n = 24) receiving tetracaine 10 mg with intrathecal morphine 0.1 mg in elective cesarean section under spinal anesthesia.. There were no significant differences between the groups in time to first postoperative supplemental analgesics, times of using postoperative supplemental analgesics and antiemetics within 24 hours after operation, and the incidence of postoperative nausea and vomiting and pruritus.. It is concluded that intrathecal buprenorphine 0.05 mg provides similar postoperative analgesic effect with intrathecal morphine 0.1 mg without any increases of side-effects in cesarean section.

Topics: Adult; Analgesics, Opioid; Anesthesia, Obstetrical; Anesthesia, Spinal; Buprenorphine; Cesarean Section; Drug Therapy, Combination; Female; Humans; Injections, Spinal; Morphine; Pain, Postoperative; Pregnancy; Retrospective Studies; Tetracaine

Tissue injury and anaesthesia during surgery induce a stress response associated with increased glucocorticoid secretion from the adrenal glands. This response alters the normal physiology and may cause postoperative morbidity, as well as affect the results during acute experiments. The aim of the present investigation was to study the effect of surgical severity and analgesic treatment on circulating corticosterone in male Sprague-Dawley rats. Male rats were treated with either lidocaine infiltrated during surgery, buprenorphine (0.05 or 0.1 mg/kg subcutaneously) or saline subcutaneously. Each treatment group was subjected to either arterial catheterisation or arterial catheterisation and laparotomy. A catheter was inserted in the common carotid artery and blood was collected during surgery and during anaesthesia 6 h after surgery. Lidocaine treatment reduced the corticosterone levels compared to saline treatment after catheterisation but not after laparotomy. Buprenorphine treatment reduced the corticosterone levels during the first hour after surgery after both catheterisation and laparotomy. The higher buprenorphine dose led to an earlier and more pronounced reduction, especially after laparotomy. In the present study, the corticosterone response during surgery in laboratory rats is correlated with the severity of the procedure, and buprenorphine reduces the surgical stress response more effectively than lidocaine treatment.

Topics: Analgesics, Opioid; Animals; Blood Pressure; Buprenorphine; Corticosterone; Laparotomy; Lidocaine; Male; Pain, Postoperative; Rats; Rats, Sprague-Dawley; Stress, Physiological

Topics: Analgesia; Analgesia, Epidural; Analgesia, Patient-Controlled; Analgesics, Opioid; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Bupivacaine; Buprenorphine; Combined Modality Therapy; Diclofenac; Humans; Pain, Postoperative; Postoperative Nausea and Vomiting

To determine whether buprenorphine maintenance alters intrapartum or postpartum pain or medication requirements.. Sixty three patients treated with buprenorphine for opioid dependence during pregnancy (vaginal n = 44; cesarean n = 19) were matched retrospectively to control women. Analgesic medication and pain scores (0-10) were extracted from the medical record. Primary endpoint: opioid utilization postpartum (oxycodone equivalents). Secondary endpoints: pain scores and intrapartum analgesia.. There were no differences in intrapartum pain or analgesia. Following vaginal birth, buprenorphine maintained women had increased pain (buprenorphine 2.7 (1.7,4.0); control 2.1 (1.2,3.0), p = 0.006) but no increase in opioid utilization (buprenorphine: 11.8 ± 24.8; control 5.4 ± 10.4 mg/24 h, p = 0.10); following cesarean delivery both pain (buprenorphine: 5.1 (4.1,6.1); control: 3.3 (2.5,4.1), p = 0.009) and opioid utilization (buprenorphine: 89.3 ± 38.0, control: 60.9 ± 13.1 mg/24 h, p = 0.004) were increased.. Buprenorphine maintained women have similar intrapartum pain and analgesic needs during labor, but experience more postpartum pain and require 47% more opioid analgesic following cesarean delivery.

Topics: Adult; Analgesics, Opioid; Buprenorphine; Cesarean Section; Cohort Studies; Female; Humans; Labor Pain; Narcotic Antagonists; Outcome Assessment, Health Care; Pain, Postoperative; Postpartum Period; Pregnancy; Retrospective Studies; Young Adult

To compare the postoperative analgesic effects of intravenous (IV), intramuscular (IM), subcutaneous (SC) or oral transmucosal (OTM) buprenorphine administered to cats undergoing ovariohysterectomy.. Randomized, prospective and blinded clinical trial.. 100 female cats.. Cats were assigned to receive 0.01 mg kg(-1) of buprenorphine administered by the IV, IM, SC or OTM route (n = 25/group). Buprenorphine was made up to 0.3 mL with 0.9% saline. DIVAS (0-100 mm) and simple descriptive scale (SDS) (from 0 to 4) pain and sedation scores were assigned to each cat before and 1, 2, 3, 4, 6, 8, 12 and 24 hours after ovariohysterectomy. Buprenorphine and carprofen were administered for rescue analgesia. Data were analyzed using anova and Fisher's exact test (p < 0.05).. There were no significant differences between groups for breed, body weight, anesthetic time or surgery time (p > 0.05). There were no significant differences between groups for sedation scores at any time. SDS pain scores did not detect any differences between groups (p > 0.05). DIVAS pain scores after OTM administration were significantly higher than IV and IM administration at 1 hour and at 3, 4, 6, 8 and 12 hours, respectively (p < 0.05). DIVAS pain scores after SC administration were significantly higher than IV and IM administration at 2 hours and at 2, 3, 4, 8, 12 and 24 hours (p < 0.05), respectively. Six, four, 13 and 17 cats that received IV, IM, SC and OTM buprenorphine required rescue analgesia, respectively. There was a significantly higher incidence of treatment failure in cats that received SC and OTM buprenorphine compared with cats that received IV and IM buprenorphine (p < 0.05).. IV and IM administration of buprenorphine provided better postoperative analgesia than SC or OTM administration of the drug and these routes of administration should be preferred when buprenorphine is administered to cats.

Topics: Administration, Buccal; Analgesia; Analgesics, Opioid; Animals; Buprenorphine; Cat Diseases; Cats; Female; Hysterectomy; Injections, Intramuscular; Injections, Intravenous; Injections, Subcutaneous; Ovariectomy; Pain Measurement; Pain, Postoperative

The purpose of this study was to determine the level of pain elicited by mammary fat pad removal surgery and the effects of postoperative analgesics on recovery. Female FVB mice were anesthetized, and mammary fat pad removal was performed. After surgery, mice received carprofen, buprenorphine, a combination of carprofen and buprenorphine, or saline treatment. Additional mice received anesthesia but no surgery or treatment. Food and water intake, body weight, wheel running activity, and a visual assessment score were recorded daily for 4 d after surgery and compared with presurgical findings. Corticosterone metabolites in fecal samples were analyzed at 12 and 24 h postsurgically and compared with baseline values. All surgical groups had significantly decreased food intake at 24 h, with a return to baseline by 48 h. The combination treatment resulted in a significantly decreased water intake and body weight at 24 h. All surgical groups had significantly decreased wheel running activity at 24 h only. The visual assessment scores indicated mild pain for all surgical groups, with the buprenorphine treated mice showing the highest pain index scores, as compared with nonsurgical controls. Fecal corticosterone metabolite levels did not differ significantly between any of the groups or across time. The parameters used in this study did not indicate that administration of these analgesic regimens improved recovery as compared with that of saline-treated mice. Care should be taken when using visual assessment scores to evaluate pain in mice, given that analgesics may have side effects that inadvertently elevate the score.

Topics: Adipose Tissue; Analgesics, Opioid; Animals; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Carbazoles; Drug Therapy, Combination; Female; Mammary Glands, Animal; Mice; Mice, Inbred Strains; Pain Measurement; Pain, Postoperative; Random Allocation; Treatment Outcome

Buprenorphine is administered to humans and animals for postoperative pain management, although its use is associated with complications. Alternative analgesics, including the nonsteroidal antiinflammatory meloxicam, are available, but information on their postoperative effects is limited. The objective of the present study was to compare buprenorphine (0.03 mg/kg SC twice daily for 3 d) with meloxicam (2 mg/kg SC initial dose followed by 1 mg/kg SC once daily for 2 d) by assessing parameters relating to postsurgical recovery in rats that underwent surgical implantation of radiotelemetric transducers. Rats treated after surgery with buprenorphine showed greater reductions in body weight, food consumption, locomotor activity, and nighttime heart rates than did meloxicam-treated rats. Buprenorphine and meloxicam treatments both had stimulatory effects on mean arterial pressure and daytime heart rate measurements, although effects on nighttime mean arterial pressure were greater in the buprenorphine-treated rats. In summary, the lesser physiologic changes associated with meloxicam, as compared with buprenorphine, suggest that meloxicam offers advantages for use as a postoperative analgesic after laparotomy and radiotelemetric transducer implantation in rats.

Topics: Analgesia; Analgesics, Opioid; Animals; Anti-Inflammatory Agents, Non-Steroidal; Blood Pressure; Body Weight; Buprenorphine; Feeding Behavior; Heart Rate; Male; Meloxicam; Motor Activity; Pain Measurement; Pain, Postoperative; Random Allocation; Rats; Rats, Sprague-Dawley; Thiazines; Thiazoles; Treatment Outcome

Assessment of pain in rabbits is challenging, and studies of effective surgical analgesia are lacking for this species. Seeking potential indicators of postoperative pain, we performed ovariohysterectomy and telemeter placement as a form of moderate surgical injury in 20 female rabbits. Rabbits were assigned to 1 of 4 treatment groups (5 per group): buprenorphine (0.02 mg/kg SC every 12 h for 3 d); fentanyl (25-μg patch placed 24 h preoperatively); ketoprofen (1 mg/kg SC every 24 h for 3 d), and control (no treatment given). Various physiologic and behavioral variables were recorded by blinded observers, including food and water consumption, fecal output, and remotely recorded behaviors during daily exercise in 1.2 × 1.8 m floor pens. Compared with preoperative values, significant declines occurred in: food consumption (days 1 to 7), water consumption (days 1 to 4), fecal output (days 1 to 2), mean travel distance, and rearing (days 1 to 3 and day 7). No single treatment proved significantly better than another. Our results demonstrate substantial inappetance and reduction of normal activity levels in rabbits after surgery. Although results from rabbits treated with empirical doses (those typically recommended) of analgesics did not appear substantially better than those from the untreated control group, comparison of other doses and multimodal analgesic techniques by using these behavioral monitoring strategies may prove useful in future studies aimed at optimizing postoperative analgesia in rabbits.

Topics: Analgesia; Analgesics, Opioid; Animals; Anti-Inflammatory Agents, Non-Steroidal; Behavior, Animal; Buprenorphine; Drinking; Eating; Female; Fentanyl; Hysterectomy; Ketoprofen; Models, Animal; Ovariectomy; Pain, Postoperative; Postoperative Period; Rabbits

It is essential to identify objective and efficient methods of evaluating postoperative pain in rodents. The authors investigated whether postoperative changes in rates of body weight gain could serve as a measure of the efficacy of meloxicam or buprenorphine analgesia in growing rats. Young adult male Lewis rats underwent general endotracheal anesthesia and thoracotomy and were treated postoperatively for 3 d with saline (no analgesia), buprenorphine (six doses of 0.1 mg per kg) or meloxicam (three doses of 1 mg per kg). The authors evaluated rats' daily growth rates for 5 d after surgery and compared them with baseline (preoperative) growth rates. To discriminate between the effects of postoperative pain and other concurrent physiologic effects associated with anesthesia, thoracotomy or analgesia, the authors evaluated weight changes in multiple control groups. Treatment with buprenorphine in the absence of any other procedure or with anesthesia alone significantly affected rats' body weight. Notably, growth rate was maintained at near normal levels in rats treated postoperatively with meloxicam. These findings suggest that growth rate might serve as an efficient index of postoperative pain after major surgical procedures in young adult rats treated with meloxicam but not in rats treated with buprenorphine.

Topics: Analgesia; Analgesics, Opioid; Animals; Anti-Inflammatory Agents, Non-Steroidal; Body Weight; Buprenorphine; Intubation, Intratracheal; Meloxicam; Pain, Postoperative; Rats; Rats, Inbred Lew; Thiazines; Thiazoles; Thoracotomy; Weight Gain

We evaluated the commonly prescribed analgesic buprenorphine in a postoperative pain model in rats, assessing acute postoperative pain relief, rebound hyperalgesia, and the long-term effects of postoperative opioid treatment on subsequent opioid exposure. Rats received surgery (paw incision under isoflurane anesthesia), sham surgery (anesthesia only), or neither and were treated postoperatively with 1 of several doses of subcutaneous buprenorphine. Pain sensitivity to noxious and nonnoxious mechanical stimuli at the site of injury (primary pain) was assessed at 1, 4, 24, and 72 h after surgery. Pain sensitivity at a site distal to the injury (secondary pain) was assessed at 24 and 72 h after surgery. Rats were tested for their sensitivity to the analgesic and locomotor effects of morphine 9 to 10 d after surgery. Buprenorphine at 0.05 mg/kg SC was determined to be the most effective; this dose induced isoalgesia during the acute postoperative period and the longest period of pain relief, and it did not induce long-term changes in opioid sensitivity in 2 functional measures of the opioid system. A lower dose of buprenorphine (0.01 mg/kg SC) did not meet the criterion for isoalgesia, and a higher dose (0.1 mg/kg SC) was less effective in pain relief at later recovery periods and induced a long-lasting opioid tolerance, indicating greater neural adaptations. These results support the use of 0.05 mg/kg SC buprenorphine as the upper dose limit for effective treatment of postoperative pain in rats and suggest that higher doses produce long-term effects on opioid sensitivity.

Topics: Analgesics, Opioid; Animals; Buprenorphine; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Therapy, Combination; Hyperalgesia; Injections, Subcutaneous; Locomotion; Male; Morphine; Pain Measurement; Pain Threshold; Pain, Postoperative; Rats; Rats, Long-Evans; Time Factors

Topics: Analgesics, Opioid; Buprenorphine; Cocaine-Related Disorders; Half-Life; Humans; Male; Middle Aged; Morphine; Pain, Postoperative; Substance-Related Disorders

Composite tissue allograft transplantation may represent the next frontier in the field of reconstructive surgery. However, the main obstacles precluding the routine use of composite tissue allotransplants are rejection and toxicity associated with life-long immunosuppressive therapy. In this study, we investigated a nontoxic immunosuppressant and cytotoxic T-lymphocyte-associated antigen 4 immunoglobulin (CTLA4-Ig)-based protocol to induce donor-specific tolerance to hind limb allografts in rats.. Fully mismatched, 4- to 10-week-old Brown Norway (BN, RT1n) and Lewis (RT1) rats were used as cell/organ donors and recipients, respectively. Recipients were treated with CTLA4-Ig (2 mg/kg/d) on days -30, -28, -26, -24, and -22, rapamycin, mycophenolate mofetil, and methylprednisolone (RAPA/MMF/MP) combined therapy (from days -30 to day 100), a single dose of anti-lymphocyte serum (10 mg, on day -30), and donor bone marrow (10 x 10(7) T-cell-depleted cells) transplantation (BMT, on day -30). Thirty days after BMT, chimeric animals received hind limb allotransplantations (on day 0). The RAPA/MMF/MP combined therapy was changed to Cyclosporine (CsA, 8 mg/kg/d) on day 100 and maintained thereafter at this level.. Hematopoietic chimerism of 17.6 +/- 9.5% at day 0, was stable (15.2 +/- 5.6%) at 230 days post-BMT; there was no sign of graft-versus-host disease. Chimeric recipients (Lewis) permanently accepted (>200 days) donor (BN)-specific (RT11, n = 6) hind limbs, yet rapidly rejected (20 +/- 2 days) third-party hind limbs (Wistar Furth [WF]). Lymphocytes of graft-tolerant animals demonstrated hyporesponsiveness in mixed lymphocyte cultures in a donor-specific manner. Tolerant graft histology showed no signs of acute and chronic rejection.. The immunosuppressant and CTLA4-Ig-based conditioning regimen with donor BMT produced mixed chimerism and induced partial donor-specific tolerance to hind limb allografts.

Topics: Abatacept; Acetaminophen; Analgesia; Analgesics; Animals; Buprenorphine; Hindlimb; Immune Tolerance; Immunoconjugates; Immunosuppressive Agents; Male; Methylprednisolone; Mycophenolic Acid; Pain, Postoperative; Rats; Rats, Inbred BN; Rats, Inbred Lew; Sirolimus; Transplantation Conditioning; Transplantation, Homologous

Buprenorphine (Bup) is the most commonly used analgesic in mice, yet few objective assessments address its superiority for postsurgical recovery. In mice, IP implantation of a radiotelemetry device induces decreases in body weight (BW), food and water intake (FI, WI), core temperature (Tc), and activity levels that persist approximately 14 d in the absence of analgesia. To compare the efficacy of Bup with that of the nonsteroidal antiinflammatory drug indomethacin (Indo) for postsurgical recovery, male C57BL/6J mice were treated on the day of radiotelemetry implantation with Bup (0.3 mg/kg s.c.) or Indo (1 mg/kg s.c.) followed by treatment with Indo (1 mg/kg p.o.) on the next day (Bup-Indo versus Indo-Indo). Responses were compared between treatments in mice implanted with a radiotelemetry device and those that did not undergo surgery. Changes in BW, FI, WI, Tc, and activity were examined throughout 14 d of recovery. Indo-Indo was more efficacious in inhibiting postsurgical BW, FI, and WI reductions, compared with Bup-Indo. Bup also reduced BW and FI in the absence of surgery, indicating a nonspecific effect of this drug on these variables. Indo-Indo treatment was associated with higher activity levels during lights-on-to-lights-off transition periods compared with that observed with Bup-Indo. According to 5 objective measures of surgical recovery, our data suggest that Indo-Indo treatment is more efficacious than is Bup-Indo for postsurgical recovery of radiotelemetry-implanted mice.

Topics: Administration, Oral; Analgesics, Opioid; Animals; Anti-Inflammatory Agents, Non-Steroidal; Body Weight; Buprenorphine; Drinking; Drug Therapy, Combination; Eating; Indomethacin; Laboratory Animal Science; Male; Mice; Mice, Inbred C57BL; Motor Activity; Pain, Postoperative; Recovery of Function; Specific Pathogen-Free Organisms; Telemetry

Many researchers are reluctant to administer analgesia after rodent embryo transfer, primarily out of concern that analgesia will affect embryo implantation. According to the Animal Welfare Act and the Guide, however, embryo transfer constitutes major survival surgery and is likely to cause pain and distress despite its minimally invasive nature. The authors examined the effects of a single dose of the analgesic buprenorphine on mice that underwent embryo transfer. In mice treated with buprenorphine, the number of viable implanted embryos was typically equal to or greater than that in untreated mice. All mice seemed quiet, alert and active after surgery.

Topics: Analgesia; Analgesics, Opioid; Animals; Buprenorphine; Embryo Implantation; Embryo Transfer; Female; Laboratory Animal Science; Male; Mice; Mice, Inbred C57BL; Pain, Postoperative; Specific Pathogen-Free Organisms

Topics: Administration, Sublingual; Adult; Analgesics, Opioid; Buprenorphine; Dose-Response Relationship, Drug; Female; Humans; Naloxone; Narcotic Antagonists; Opioid-Related Disorders; Pain, Postoperative; Self Administration; Surgical Procedures, Operative

Buprenorphine is a widely used analgesic for relief of postoperative pain in rats. The effect of repeated doses of buprenorphine throughout the postoperative pain and stress response is unknown. This investigation tested the hypotheses that (a) daily analgesic doses of buprenorphine for 7 d ameliorate the stress response after laparotomy in rats and (b) preoperative buprenorphine better ameliorates the response than do peri- and postoperative administration. Postoperative effects on body weight, daily food and water consumption, and daily fecal and urinary outputs were monitored in groups of rats treated for 7 d with analgesic doses of buprenorphine initiated at different time points relative to the time of laparotomy. Analgesic doses of buprenorphine had no effect on the study parameters in healthy unoperated rats. Daily injection of buprenorphine delayed the time at which the preoperative body weight was restored without decreasing the postoperative changes in daily food consumption, water intake, and fecal and urinary outputs in the operated rats. The effects of daily analgesic doses of buprenorphine for 7 d on body weight, daily food, and water consumption, and fecal and urinary outputs were minimal and less statistically significant than the changes caused by surgery itself. However, this dosing regimen seems to delay the restoration of body weight after abdominal surgery in rats.

Topics: Analgesics, Opioid; Animals; Body Weight; Buprenorphine; Digestive System Surgical Procedures; Drug Administration Schedule; Female; Pain, Postoperative; Postoperative Care; Rats; Rats, Wistar

This study evaluated the duration of clinical effects and referred hyperalgesia in rats (n = 10 per group) undergo ing abdominal surgery with analgesics (ketoprofen at 3 mg/kg and buprenorphine at 0.01 or 0.1 mg/kg) administered intramuscularly twice daily for 72 h beginning prior to surgery; no-surgery and no-analgesia control groups were included. Food and water consumption and body weight were monitored daily. As a measure of referred hyperalgesia, tail-flick latency was measured daily, before and 4 h after analgesia administration. Compared with those of the no-surgery controls, significant decreases in food consumption and body weight occurred 24 h after surgery without analgesics. There were nonsignificant reductions in these effects by analgesics, but the benefits were not significantly different than those of saline. These parameters continued to be decreased with variable significance in the buprenorphine groups at 48 and 72 h after surgery. In both buprenorphine-treated groups, water consumption was significantly increased at 24 h after surgery but not at 48 or 72 h. Tail-flick latency was not significantly different between the no-surgery and no-analgesia groups but was significantly increased 4 h after high-dose buprenorphine administration and declined nonsignificantly over time in the other groups. We conclude that painful effects from surgery are present primarily during the first 24 h after surgery. The analgesic regimens tested did not completely reduce these effects. Buprenorphine was associated with adverse effects for as long as 72 h after surgery. Referred hyperalgesia from this abdominal surgery could not be measured using the tail-flick assay.

Topics: Abdomen; Analgesics, Opioid; Animals; Anti-Inflammatory Agents, Non-Steroidal; Body Weight; Buprenorphine; Drinking; Eating; Hot Temperature; Hyperalgesia; Ketoprofen; Pain Measurement; Pain, Postoperative; Rats; Time Factors

There have been several reports of instillation of buprenorphine in the intact epidural space in an attempt to control postoperative pain, but none in which an absorbable gelatin sponge soaked with buprenorphine is placed directly in the epidural space. In the present study, carried out on 30 patients (study group) undergoing noncervical laminectomies, 0.3 mg buprenorphine diluted to 5 mL with normal saline soaked into an absorbable gelatin sponge was placed in the epidural space under direct vision. In 30 other patients (control group) undergoing laminectomies, absorbable gelatin sponge soaked with 5 mL normal saline was placed in the epidural space. Pulse rate, mean arterial pressure, respiratory rate, pain score by visual analog scale, duration of analgesia, and adverse effects, if any, were noted preoperatively and postoperatively at 1, 2, 3, 4, 5, 6, 12, 18, and 24 hours. The presence of any neurologic symptoms was also assessed at these time intervals as well as on the seventh postoperative day. The authors observed that changes in pulse rate, mean arterial pressure, and respiratory rate were not statistically significant between the control and the study groups. The pain relief score, duration of pain relief (14.8 +/- 0.77 hours in the study group vs. 0.66 +/- 0.15 hours in the control group), and sedation were significantly better in the study group. No patient demonstrated any respiratory depression (respiratory rate <12/min), bradycardia, pruritus, or neurologic pressure symptoms, although the incidence of nausea was higher in the study group.

Topics: Absorption; Administration, Topical; Adult; Analgesics, Opioid; Anesthesia, General; Blood Pressure; Buprenorphine; Female; Gelatin; Heart Rate; Hemodynamics; Humans; Laminectomy; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Postoperative Nausea and Vomiting; Respiratory Mechanics

Topics: Analgesia; Analgesics, Opioid; Animal Use Alternatives; Animals; Buprenorphine; Cerebral Arteries; Minor Surgical Procedures; Pain Measurement; Pain Threshold; Pain, Postoperative; Rats; Rats, Wistar; Research Design; Review Literature as Topic

Effective postoperative analgesia is essential for improving patient well-being and decreasing morbidity. Historical recommendations of postoperative analgesics have been based on their effectiveness in attenuating a nociceptive response in animals that have not undergone a surgical procedure, potentially leading to over- or underestimation of postoperative analgesia requirements. This study was designed to evaluate the efficacy of four analgesics in a model of postsurgical pain, which involves surgical incision of the plantar aspect of the hindpaw in halothane-anesthetized rats. The hindpaw was selected as the injury site because it permits quantitative assessment of mechanical sensitivity, which increases as a consequence of tissue damage. As the primary endpoints for postoperative recovery, mechanical sensitivity and weight gain were determined for 5 days. Analgesic regimens included buprenorphine (0.025, 0.05, and 0.1 mg/kg subcutaneously [s.c.]; 1 ml/kg), fentanyl (0.01 and 0.1 mg/kg intraperitoneally [i.p.]; 1 ml/kg), flunixin meglumine (1.1 and 2.5 mg/kg, s.c.; 1 ml/kg) and acetaminophen (100 and 300 mg/kg orally; approximately 3 & 10 ml/kg). Drugs were administered once daily on days 0, 1, and 2 postoperatively. Buprenorphine, fentanyl, and flunixin all significantly decreased mechanical sensitivity, but buprenorphine provided the highest degree of analgesia during the postoperative treatment period. However, rats treated with buprenorphine exhibited heightened mechanical sensitivity once treatment was discontinued on day 2. Moreover, buprenorphine also compromised weight gain as compared to that of vehicle-treated animals. These findings suggest that potent nonsteroidal anti-inflammatory agents, such as flunixin, may be useful alternatives to opioid-based agents for the control of acute postoperative pain associated with a minor surgical procedure and highlight the importance of assessing the risk-benefit ratio when selecting analgesics and dosing regimens.

Topics: Acetaminophen; Analgesia; Analgesics; Animals; Biomechanical Phenomena; Buprenorphine; Clonixin; Fentanyl; Hindlimb; Kinetics; Male; Models, Animal; Pain Measurement; Pain, Postoperative; Rats; Rats, Sprague-Dawley; Weight Gain

We evaluated the requirement for postoperative analgesics in 88 patients undergoing abdominal total hysterectomy with inhalation anesthesia or with total intravenous anesthesia.. Anesthesia was induced in the inhalation anesthesia (GOS, n = 52) group with propofol and fentanyl, and maintained with sevoflurane, nitrous oxide balanced with oxygen, and additional administrations of fentanyl up to 0.2 mg in total. The patients in the total intravenous anesthesia (TIVA, n = 36) group were managed with target controlled infusion for propofol and intermittent administration of fentanyl. Effect site concentrations of fentanyl at the end of surgery were calculated using a pharmacokinetic-pharmacodynamic model. We divided the postoperative time course and evaluated the types, dosages, and prescription times of postoperative analgesics in each.. Both total dosage and effect-site concentration of fentanyl were higher in the TIVA group than in the GOS group, and total prescription time in the TIVA group was significantly less during the 24 hrs after the operation. Supplemental prescription intervals of buprenorphine were significantly less in the TIVA group. Since administration of fentanyl during operation was adequate, patients in the TIVA group were considered to be in a sufficient analgesic state at the end of operation.. The postoperative pain can be reduced with TIVA.

Topics: Adult; Aged; Analgesics, Opioid; Anesthesia, Inhalation; Anesthesia, Intravenous; Buprenorphine; Female; Fentanyl; Humans; Hysterectomy; Middle Aged; Pain, Postoperative; Patient Satisfaction

Appropriate and efficacious use of analgesics in rodents must be balanced judiciously between animal needs and research objectives. A concern in many studies is that analgesia will confound experimental outcome or interpretation. Accordingly, determining whether rats subjected to surgical protocols show evidence of pain is important if we are to provide rational postoperative analgesia without compromising experimental objectives. The goal of this study was to evaluate both subjective and objective measures for pain evaluation in male Wistar rats subjected to sham middle cerebral artery occlusion (MCAO) surgery and to determine whether buprenorphine would be an appropriate analgesic in this surgical model. Male Wistar rats underwent a sham 2-h MCAO by the intraluminal filament technique followed by 22-h of recovery. Animals were randomly assigned to one of three postoperative treatment groups: vehicle only (VH; vehicle subcutaneously [s.c.] + plain jello orally), low-dose buprenorphine (LB; 0.05 mg/kg s.c. _ 0.25 mg/kg drug-in-jello orally), and high-dose buprenorphine (HB; 0.5 mg/kg s.c. + 0.25 mg/kg drug-in-jello orally). Animals received subcutaneous treatments prior to anesthetic recovery and approximately 18-h later. Jello treatments were given once at the end of the surgery day. We modified a previously published behavioral scoring system which is based on subjective and objective measures for pain evaluation. All animals were evaluated for pain before sham surgery (baseline) and at 3-, 18-, and 22-h postoperatively by observers who were blinded to treatment group. Brains were removed at 22-h after surgery and evaluated by 2,3,5-triphenyltetrazolium chloride staining to confirm lack of brain injury from the sham procedure. Sham intraoperative physiological variables were equivalent among treatment groups. Baseline assessment scores were zero for all groups. Postoperatively, all treatment groups showed elevated assessment scores relative to baseline values. Buprenorphine at the tested doses did not markedly reduce total assessment scores postoperatively relative to those in vehicle-treated animals. Further evaluation of rodent postoperative pain and response to analgesia is needed if we are to formulate a sound scientific approach to animal management in protocols requiring surgical manipulations.

Topics: Administration, Oral; Analgesia; Analgesics, Opioid; Animals; Buprenorphine; Cerebral Arteries; Dose-Response Relationship, Drug; Male; Minor Surgical Procedures; Pain Measurement; Pain, Postoperative; Rats; Rats, Wistar; Single-Blind Method

Results of using an implantable osmotic pump, a preset disposable infusion pump, or a reusable programmable infusion pump for postoperative administration of buprenorphine or morphine in dogs undergoing abdominal surgery are described. Ten dogs underwent abdominal surgery for implantation of vascular access ports. Dogs were given buprenorphine s.c. by use of an implantable osmotic pump (4 dogs), morphine s.c. by use of a preset infusion pump (4), or buprenorphine intra-arterially by use of a programmable infusion pump (2). Dogs were monitored, and serum buprenorphine or morphine concentration was measured for 72 hours after surgery; pumps were removed 48 hours after surgery. Severity of pain was determined by assigning a pain score. The preset infusion pump and the programmable infusion pump resulted in comparable pain relief and sustained serum analgesic concentrations throughout the recovery period. However, the cost of the pumps and other associated factors may limit their use to dogs undergoing invasive surgical procedures expected to result in substantial postoperative pain. The level of analgesia obtained with the implantable osmotic pumps was inconsistent.

Topics: Abdomen; Analgesics, Opioid; Animals; Buprenorphine; Disposable Equipment; Dogs; Infusion Pumps; Infusion Pumps, Implantable; Morphine; Pain Measurement; Pain, Postoperative; Postoperative Care; Time Factors

Topics: Analgesia; Analgesics, Opioid; Animal Welfare; Animals; Behavior, Animal; Buprenorphine; Pain, Postoperative; Pica; Rats

A retrospective study was performed to compare the hemodynamic effect and postoperative pain relief of fentanyl (Group F, n = 11) and buprenorphine (Group B, n = 11) in total intravenous anesthesia (TIVA) using propofol during spinal surgery. All patients were premedicated with midazolam (3-5 mg) i.m. Anesthesia was maintained with propofol infusion, and increments of fentanyl or single dose of buprenorphine with 40% oxygen in air. Total doses of fentanyl and buprenorphine were 7.6 +/- 1.0 micrograms.kg-1 and 2.0 +/- 0.4 micrograms.kg-1, respectively. Maintenance doses of propofol (Group F: 5.5 +/- 0.8 mg.kg-1.h-1, Group B: 5.9 +/- 1.1 mg.kg-1.h-1) and vecuronium were not significantly different. Mean arterial pressures from 2 hours after incision to the end of surgery were elevated significantly in Group F than in Group B. Recovery time (Group F 12.5 +/- 6.1 min vs Group B 11.8 +/- 6.1 min) and extubation time (Group F 19.5 +/- 10.3 min vs Group B 15.0 +/- 7.0 min) were not different. At the end of anesthesia, seven patients in Group F and one patient in Group B (P < 0.01) complained of severe pain. All patients in Group F, and only two in Group B (P < 0.02) received analgesics within 20 hours. Neither nausea nor respiratory depression was found in both groups. This study suggests that buprenorphine would provide a more stable hemodynamic state and better postoperative pain relief than fentanyl in TIVA using propofol.

Topics: Adjuvants, Anesthesia; Adult; Aged; Analgesics, Opioid; Anesthesia, Intravenous; Anesthetics, Intravenous; Buprenorphine; Female; Fentanyl; Hemodynamics; Humans; Male; Middle Aged; Pain, Postoperative; Propofol; Retrospective Studies; Spine

The study examined the use of behaviour in assessing post-laparotomy pain in rats given subcutaneous injections of saline (0.2 ml 100 g(-1)) or the analgesics buprenorphine (0.05 mg kg(-1)) or ketoprofen (5 mg kg(-1)). Procedural control influences (handling/movement, anaesthesia, injections) were studied in a second group. Of 150 behaviours examined, discriminant analysis classified the main treatment effects, and class mean frequencies were compared between treatments within each group. With the exception of buprenorphine treatment, control procedures reduced the frequency of active, attentive and grooming behaviour, and increased sleeping during 24 hours following each treatment. Moving animals to the theatre was the main factor responsible for these changes. Surgery also reduced active and attentive behaviour. Animals given pre-operative saline were more frequently inactive than those given ketoprofen. These effects most likely resulted from post-surgery pain, but this was not significantly diminished with the ketoprofen dose used. In all cases, buprenorphine outweighed these effects, causing a sustained increase in active, inactive and attentive behaviour, such that determination of any analgesic effects was impossible. The study underlined a role for pain assessments based on rat behaviour. Drug-related effects emphasised a need for more comprehensive assessments encompassing procedural influences, before behaviour changes that are potentially pain related may be determined accurately.

Topics: Analgesics; Animals; Behavior, Animal; Buprenorphine; Female; Ketoprofen; Male; Pain, Postoperative; Random Allocation; Rats; Rats, Wistar

The effects of oral administration of buprenorphine ('buprenorphine jello'), a partial mu opioid agonist, oral naltrexone, a mu antagonist and morphine, a mu agonist, were investigated in rats following laparotomy. Food and water consumption and body weight were reduced in rats that underwent surgery. Rats undergoing anaesthesia alone showed only a small reduction in water consumption. Administration of oral buprenorphine (0.5 mg/kg in flavoured gelatin) decreased the effects of surgery on body weight and water intake when compared to untreated (vehicle alone) controls. The magnitude of this beneficial effect was similar to that seen in previous studies using subcutaneous administration of buprenorphine. The fall in body weight and food and water intake following surgery was similar in the groups which received morphine and the control group which received vehicle (jelly). Neither the magnitude of the fall in body weight, and food and water intake, nor the behavioural scores differed between naltrexone and control (vehicle alone) rats following surgery. This suggests that the beneficial effects of partial agonist analgesics are mediated by a reduction in pain rather than by antagonism of endogenous opioids. Both anaesthesia and surgery caused changes in behaviour, but the major effects of buprenorphine in normal (unoperated) rats severely limited the value of behavioural parameters as a means of assessing possible beneficial effects of analgesic administration.

Topics: Administration, Oral; Analgesics, Opioid; Animals; Behavior, Animal; Body Weight; Buprenorphine; Drinking; Eating; Laparotomy; Male; Morphine; Naltrexone; Narcotic Antagonists; Pain, Postoperative; Rats; Rats, Wistar; Specific Pathogen-Free Organisms

We report the effect of pre-incisional caudal epidural injection of a mixture of 20 ml 0.25% bupivacaine and 0.1 mg buprenorphine performed under general anaesthesia for relieving wound pain after posterior interbody fusion and laminotomy for spinal stenosis. Pain was compared in groups with and without blockade: 24 and 23 patients with fusion, and 30 and 28 with laminotomy respectively. In the first 12 h after each operation, the group with blockade required additional analgesics less frequently and had a lower visual analogue scale score than those without blockade. In, and after, the second 24 h patients with hypotension of 10 mm Hg, or more, after the blockade required additional analgesics less frequently than those without blockade for both operations and had a lower visual analogue score than those without blockade for laminotomy, but not for fusion. This is a simple procedure for relieving wound pain and in patients with hypotension caused by the block, the effect continued even after the analgesic action had disappeared.

Topics: Adult; Aged; Analgesics, Opioid; Anesthesia, Caudal; Anesthetics, Local; Bupivacaine; Buprenorphine; Evaluation Studies as Topic; Female; Humans; Injections, Spinal; Lumbar Vertebrae; Male; Middle Aged; Pain, Postoperative; Spinal Stenosis

We investigated the effect of epidural buprenorphine on diaphragmatic function using respiratory inductive plethysmography (RIP) in seven healthy patients after upper abdominal surgery. After surgery, changes of rib cage contribution to tidal volume (%RC) increased significantly from 25.3 +/- 7.3 (mean +/- SD) to 50.7 +/- 14.8% (P < 0.05). After the injection of epidural buprenorphine, visual analogue scale (VAS) score decreased significantly from 8.3 to 3.3 (P < 0.05). But, %RC was unchanged compared to the value before the injection. These results indicate that pain relief by epidural buprenorphine does not improve diaphragmatic function after upper abdominal surgery.

Topics: Abdomen; Adult; Analgesia, Epidural; Analgesics, Opioid; Buprenorphine; Diaphragm; Humans; Male; Middle Aged; Pain, Postoperative

Opioids are among the most ancient and widely used drugs in anaesthesiology. The pharmacology of opioid analgesics and their receptors is a complex and not fully understood matter; even more complex are the interactions between different classes of opioids at both molecular and clinical levels. We want to report here a clinical observation to emphasize the importance of the theoretical basis of anaesthesiology. This paper contains a clinical observation of respiratory depression following the administration of buprenorphine as postoperative analgesic after balanced anaesthesia with fentanyl. The observed case is interpreted in the light of the pharmacokinetics and pharmacodynamics of the different classes of opioid drugs (agonists, agonists-antagonists, antagonists) and of the interactions with their respective receptors.

Topics: Analgesics, Opioid; Anesthesia; Buprenorphine; Child; Depression, Chemical; Female; Fentanyl; Humans; Pain, Postoperative; Respiration; Respiratory Insufficiency

In this study investigations were carried out on pharmacokinetics of buprenorphine after it had been applied subcutaneously. Up to now no pharmacokinetic data exist using this kind of application with relevant clinical doses.. With 6 patients, who had major general surgery under balanced anaesthesia, buprenorphine was given in a single subcutaneous injection of 5 micrograms/kg bodyweight for postoperative pain relief. Over a period of 48 hours the level of buprenorphine in blood plasma was measured. The analyses were done with a modified HPLC method with electrochemical detection which is able to achieve measurements as low as 40 pg/ml of plasma. The pharmacokinetic values were calculated with the "Topfit" pharmacokinetic computerised programme.. Whereas the period of time (tmax) to reach peak plasma concentration (Cmax) after subcutaneous application is much longer than with other parenteral application forms, the plasma concentration levels tend to be similar after 20 minutes. The most important finding of this study is that the mean terminal half-life (t1/2c) of buprenorphine is 23 hours. However, the presently available data for other application forms in respect to terminal half-life did not produce the same results. This can be explained by the use of insufficiently sensitive analytical procedures and by too short periods of observation of 3 and 13 hours respectively, leading to values of t1/2c of 2 and 5 hours.. These results indicate that the terminal half-life (t1/2c) of buprenorphine is much longer than had been supposed. It confirms clinical findings of sufficient pain relief by showing measurable uptake of buprenorphine after subcutaneous application.

Topics: Aged; Aged, 80 and over; Analgesics, Opioid; Buprenorphine; Female; Half-Life; Humans; Injections, Subcutaneous; Male; Metabolic Clearance Rate; Middle Aged; Pain Measurement; Pain, Postoperative

Intrathecal morphine (Mor) exerts potent analgesic effect and decreases anesthetic requirement. However, morphine was reported to have various uncomfortable side effects, and buprenorphine (BPN) is considered as an alternative opioid. The aim of this study was to investigate the effect of intrathecal BPN and Mor on the MAC of halothane and the relief of postoperative pain. The result shows that the MAC of halothane decreases dose dependently both in the BPN and Mor groups. The decrease in halothane MAC with 0.05 mg intrathecal BPN was equipotent with the intrathecal administration of 0.5 mg Mor. Adequate postoperative analgesia and severe pruritus were observed in the 0.5 mg Mor group. The intrathecal administration of 0.05 mg and 0.075 mg BPN has shown mild analgesic effect without any side effects.

Topics: Adult; Buprenorphine; Female; Halothane; Humans; Injections, Spinal; Middle Aged; Morphine; Pain, Postoperative; Pulmonary Alveoli

To evaluate postoperative analgesia and side effects of epidural buprenorphine, 100 patients who underwent upper abdominal surgery were divided into 5 groups. All patients were given initially 0.1 mg of buprenorphine in 8 ml of 0.25% bupivacaine in bolus. Following an epidural bolus, 20 patients in each group were given 0.25% bupivacaine alone (group A), 5 micrograms buprenorphine in 1 ml of 0.25% bupivacaine (group B), 8 micrograms buprenorphine in 1 ml of 0.25% bupivacaine (group C), 12 micrograms buprenorphine in 1 ml of 0.25% bupivacaine (group D), or 15 micrograms buprenorphine in 1 ml of 0.25% bupivacaine (group E) with a portable disposable device at a rate of 1 ml.h-1 for 48 h. The analgesic efficacy in group E was superior to that in groups A, B, C and D. No significant difference was found in the incidence of side-effect among 5 groups. Therefore, epidural buprenorphine 15 micrograms in 1 ml of 0.25% bupivacaine given to patients at a rate of 1 ml.h-1 was thought to be optimal for postoperative pain relief in upper abdominal surgery in terms of its efficacy and side effects. However, 35% of these patients required supplementary systemic analgesics in the early postoperative period.

Topics: Abdomen; Analgesia, Epidural; Buprenorphine; Female; Humans; Injections, Epidural; Male; Middle Aged; Pain, Postoperative

Rats underwent a midline laparotomy and received buprenorphine, buprenorphine together with carprofen, flunixin or carprofen alone while a control group received saline. Food and water intakes and body weight were reduced following surgery in the saline control group. The degree of depression of these variables was significantly reduced by the administration of either buprenorphine or carprofen. In all groups of rats locomotor activity was depressed following surgery. Analgesic administration had little influence on these changes in activity, although administration of two doses of buprenorphine (0.05 mg/kg, 9 h interval) reduced the degree of depression in comparison to the saline control group. If the depression in food and water consumption is related to the presence of post-operative pain, then these findings suggest that analgesics should be administered to rats following surgical procedures.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Body Weight; Buprenorphine; Carbazoles; Clonixin; Drinking; Drug Therapy, Combination; Eating; Laparotomy; Male; Motor Activity; Pain, Postoperative; Rats; Rats, Wistar

The efficacy of wound perfusion (WP) with lidocaine for postoperative pain relief was studied in patients with median incision for cholecystectomy. Twenty four patients were divided into 3 groups according to the method of postoperative pain relief; group C, n = 8: intramuscular injections of penta-zocine 30 mg administered on demand, group WP, n = 8: WP with continuous lidocaine perfusion for 24 hours (plus pentazocine on demand); group EPI, n = 8: buprenorphine administered epidurally for 24 hours (plus pentazocine on demand). Pain scores at 0, 6, 12, 24, 48, hours after operation were examined. Arterial blood gas analysis, FVC and FEV1 were measured preoperatively and on the first postoperative day. Pain scores at 0 and 24 hours in group WP and EPI were significantly lower than those in group C. There were no significant differences in the scores between group WP and EPI at all the points. Analgesic requirement was significantly reduced in group WP and EPI compared with group C. FVC, FEV1 and PaO2 were significantly reduced postoperatively in every group but there were no differences among three groups. PaCO2 significantly increased postoperatively in group C and EPI. We conclude that the technique of wound perfusion with lidocaine is effective and safe for postoperative pain relief.

Topics: Adult; Aged; Buprenorphine; Cholecystectomy; Humans; Injections, Epidural; Injections, Intralesional; Injections, Intramuscular; Lidocaine; Middle Aged; Pain, Postoperative; Pentazocine; Perfusion

The effect of three solutions on postoperative pain relief by continuous epidural infusion was studied. Seventy-five patients after upper or lower abdominal surgeries were assigned to one of three groups and the postoperative pain relief was evaluated for 48 hours. Group I: bolus injection of buprenorphine (Bn) 0.1 mg + saline (S) 8 ml and continuous infusion (2 ml.h-1) of Bn 0.8 mg + S 92 ml; Group II: bolus injection of Bn 0.1 mg + 0.5% bupivacaine (Bc) 4 ml + S 4 ml and continuous infusion of Bn 0.8 mg + S 92 ml; Group III: bolus injection of Bn 0.1 mg + 0.5% Bc 4 ml + S 4 ml and continuous infusion of Bn 0.8 mg + 0.5% Bc 40 ml + S 60 ml. The combination of buprenorphine with low-dose bupivacaine (Group III) offered the most effective postoperative analgesia in three groups without increasing the frequency of adverse effects induced by epidural administration of local anesthetics. However, even in Group III, the percentage of patients complaining of pain at bed rest was still high during early postoperative period (56% at 6 hours postoperatively). The results suggest that further consideration is necessary on agents selection and dosage adjustment for the postoperative epidural analgesia.

Topics: Aged; Bupivacaine; Buprenorphine; Female; Humans; Infusions, Intravenous; Injections, Intravenous; Male; Middle Aged; Pain, Postoperative; Surgical Procedures, Operative

The effects of cervical epidural morphine and buprenorphine on postoperative pain were studied in 12 patients who received thoracic surgery twice. The patients who had received morphine 3 mg on the first operation were given buprenorphine 0.15 mg on the second operation, and the others received them vice versa. Morphine or buprenorphine was administered with 6 ml of 0.25% bupivacaine before skin incision. The duration of pain relief with morphine was longer (21.5 +/- 4.0 h) than with buprenorphine (13.9 +/- 7.8 h). The result of the questionnaires to the patients after operation shows that 10 patients (84%) were satisfied with morphine whereas only 6 patients (50%) were satisfied with buprenorphine. Seven patients preferred morphine to buprenorphine for postoperative analgesia, and the rest of the patients stated that analgesic effects were similar between the two. It seems that epidural morphine 3 mg may give more excellent postoperative pain relief after the thoracic surgery than epidural buprenorphine 0.15 mg.

Topics: Aged; Analgesia, Epidural; Buprenorphine; Female; Humans; Male; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Thoracic Surgery

A 48-year-old man who had undergone thoracotomy for carcinoma of the middle third of his oesophagus developed severe postoperative respiratory depression following intramuscular ketorolac 30 mg 2 h after 150 micrograms epidural buprenorphine. Summation of analgesia by drugs used in combination can have deleterious respiratory effects.

Topics: Analgesia, Epidural; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Buprenorphine; Depression, Chemical; Drug Interactions; Esophageal Neoplasms; Esophagectomy; Humans; Injections, Intramuscular; Ketorolac; Male; Middle Aged; Pain, Postoperative; Respiratory Insufficiency; Tolmetin

Postoperative analgesia with epidurally injected buprenorphine and its side effects were investigated in 100 patients who had received lower abdominal surgery. All patients received initially 8 ml of bupivacaine and 0.1 mg of buprenorphine. Following bolus epidural injection, five different groups of 20 patients each received either bupivacaine alone (group A), 5 micrograms.ml-1 buprenorphine.bupivacaine mixture (group B), 8 micrograms.ml-1 buprenorphine.bupivacaine mixture (group C), 12 micrograms.ml-1 buprenorphine.bupivacaine mixture (group D), or 15 micrograms.ml-1 buprenorphine.bupivacaine mixture (group E) by a portable disposable device at a rate of 1 ml.h-1 for 48 h. The analgesic efficacy in group E was superior to those in groups A, B, C or D. No significant difference in the incidence of side-effect was found among groups C, D, E. We conclude that a dose of a approximately 15 micrograms.h-1 might be optimal for postoperative pain relief after lower abdominal surgery.

Topics: Abdomen; Analgesia, Epidural; Bupivacaine; Buprenorphine; Female; Humans; Male; Middle Aged; Nausea; Pain, Postoperative; Vomiting

The post-operative effects of laparotomy and common bile-duct ligation were investigated in rats. Bile-duct ligation caused a significant reduction in food and water consumption, body weight and locomotor activity in the immediate post-operative period. Animals which underwent laparotomy in which bile-duct ligation was not carried out (sham operated groups) had significantly less depression of food and water consumption and body weight than groups which underwent bile-duct ligation. The detrimental effects on food and water consumption and body weight could be significantly reduced by the administration of buprenorphine (0.05 mg/kg, s/c), but not by infiltration of the surgical wound with the long-acting local anaesthetic agent, bupivacaine. The reduction of the depressant effects of surgery on food and water consumption by the opioid analgesic buprenorphine suggests that some of these changes may be related to the presence of post-operative pain.

Topics: Animals; Bile Ducts; Body Weight; Bupivacaine; Buprenorphine; Laparotomy; Ligation; Male; Pain, Postoperative; Postoperative Period; Rats; Rats, Wistar

This study examined analgesic efficacy and adverse effects of buprenorphine and fentanyl for the postoperative pain relief by continuous epidural infusion. Fifty patients after upper or lower abdominal surgeries were assigned to two groups and buprenorphine and fentanyl were epidurally administered postoperatively. Buprenorphine (B) group received bolus injection of B 0.1mg + saline 8 ml and continuous infusion of B 0.8 mg+saline 92 ml (2 ml.h-1). Fentanyl group received bolus injection of F 0.1 mg+saline 6 ml and continuous infusion of F 0.6 mg+saline 84 ml (2 ml.h-1). There was no significant difference between the two groups in the analgesic efficacy, which became lower from 2 to 12 hours postoperatively. However, compared with buprenorphine group, the incidence of nausea or vomiting and dizziness was significantly less in the fentanyl group (11 vs. 4 cases and 7 vs. 1 cases). These results imply that the major site of action of epidurally administered fentanyl is the spinal cord. In contrast, analgesic effect of epidural buprenorphine appears to be enhanced by the supraspinal action. We conclude that fentanyl is superior to buprenorphine for postoperative pain relief by continuous epidural infusion.

Topics: Abdomen; Aged; Buprenorphine; Dizziness; Female; Fentanyl; Humans; Injections, Epidural; Male; Middle Aged; Nausea; Pain, Postoperative; Vomiting

We surveyed the attitudes of general surgical patients to the management of their postoperative pain relief. Elective surgical patients (n = 232) were asked postoperatively about their experienced pain which was expressed according to verbal pain scale, the duration of experienced pain, satisfaction with pain relief and medication, and expectations of pain on the 5th to 7th postoperative day. Thirteen percent of the patients had no pain, 47% of whom had no rest pain but pain on moving or coughing, 32% of whom had rest and moving pain, and 0.4% of whom experienced horrible and excruciating pain. Duration of postoperative pain was 2.5 +/- 1.9 days, and 76% of the patients experienced pain only for 3 postoperative days. Results of the interviews indicated that 80% of these patients were satisfied with their postoperative pain relief. Although 80% expressed satisfaction, 39% of whom did have rest pain. In the patients with continuous epidural infusion of buprenorphine and 0.25% bupivacaine, incidence of complained rest pain was significantly low compared with those with intermittent i.v. and/or im injection of analgesics on demands of patients. Lag between patient's demand and nurse's response concerning medication correlated significantly to the satisfaction. There was no relation between satisfaction and age, the nature of operation or sex. Fifty-two percent of the patients reported that degree of experienced pain had been less than expected preoperatively. In conclusion, 80% of the patients were satisfied, but our postoperative pain therapy was still insufficient because 39% of them had rest pain.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analgesics; Bupivacaine; Buprenorphine; Female; Humans; Injections, Epidural; Male; Middle Aged; Pain, Postoperative; Patient Satisfaction; Surveys and Questionnaires

Seventy female patients scheduled for elective mastectomy were divided into three groups: Buprenorphine suppository (BPS) 0.4 mg group (n = 29); BPS 0.2 mg (n = 23) group; and control (scopolia extract and tannic acid suppository) group (n = 18). Suppositories were administered rectally to patients of each group one hour before induction of anesthesia. Plasma buprenorphine concentrations, sedation scores at entering the operating room, postoperative pain scores and side effects were evaluated. There were no significant differences in sedation effects of suppository among the three groups. Although there were significant differences in pain scores except at the time when patients left the operating room between BPS 0.2 mg group and the control group, postoperative pain relief in BPS 0.2 mg group was judged not enough. However, postoperative pain relief was more satisfactory in the BPS 0.4 mg group. Plasma concentrations of the BPS 0.4 mg group were higher than those of the BPS 0.2 mg group. Although nausea and vomiting were observed in 5 patients (17.2%) of the BPS 0.4 mg group and 4 patients (17.4%) of the BPS 0.2 mg group, respiratory depression and changes in blood pressure and heart rate were not observed in all groups. In conclusion, preanesthetic administration of the BPS 0.4 mg seemed to be useful for postoperative pain relief after elective mastectomy.

Topics: Adolescent; Adult; Aged; Buprenorphine; Female; Humans; Mastectomy; Middle Aged; Pain, Postoperative; Preanesthetic Medication; Suppositories

The purpose of this study was to investigate the effect of different pain-relief methods (regional and systemic) following thoracotomies on the cardiovascular system, pulmonary gas exchange, various endocrine parameters and subjective perception. A further aspect was to evaluate the benefits of interpleural analgesia as a new regional technique against already established regional techniques, such as intercostal nerve block and thoracic epidural block. All postoperative pain methods led to a significant time-dependent reduction of the adrenaline concentrations in plasma while the noradrenaline concentrations did not change significantly. There were no statistical differences in catecholamine concentrations among the different study groups, although the mean concentrations of adrenaline in patients having a thoracic epidural block for pain relief were lower in comparison to the findings in other groups. The plasma concentrations of the "stress metabolites", such as glucose, free fatty acids and lactate, as well as the haemodynamic (mean arterial pressure, heart rate) and pulmonary parameters (blood gas analyses), showed no significant differences among groups. In contrast to the other pain-relieving methods, interpleural analgesia did not lead to sufficient pain relief in that 7 out of 10 patients needed supplementary systemic opioid therapy. Therefore, interpleural analgesia for pain relief following thoracotomies cannot be recommended.

Topics: Adrenocorticotropic Hormone; Adult; Aged; Analgesia, Epidural; Anesthesia, Conduction; Blood Glucose; Bupivacaine; Buprenorphine; Epinephrine; Fatty Acids, Nonesterified; Female; Humans; Hydrocortisone; Infusions, Intravenous; Intercostal Nerves; Lactates; Lactic Acid; Male; Middle Aged; Nerve Block; Norepinephrine; Pain Measurement; Pain, Postoperative; Pleura; Pulmonary Gas Exchange; Thoracotomy

Topics: Analgesia, Epidural; Analgesia, Patient-Controlled; Buprenorphine; Fentanyl; Humans; Pain, Postoperative

The safety and efficacy of epidural opioids as postoperative analgesics for children with cerebral palsy were studied in 85 pediatric patients with cerebral palsy. The patients were 5 to 15 years of age and were undergoing elective orthopedic operations on the lower extremities. These patients were divided into four groups. All the patients received inhalational anesthesia combined with caudal anesthesia, while the patients in groups 2, 3, and 4 were given epidural morphine (40 micrograms.kg-1), buprenorphine (3 micrograms.kg-1), or butorphanol (30 micrograms.kg-1) at the end of operation, respectively. Number of patients who received analgesics more than 2 times within 24 hours after operation was larger in group 1 than in groups 2-4. Although groups 2-4 compared with group 1 were still sedated at 24 hours after the operation, there was no difference in degree of sedation among the groups 2-4. The epidural opioids did not increase the frequency of side effects such as nausea, vomiting etc. The authors conclude that epidural opioids achieve safe and useful postoperative pain control in children with cerebral palsy.

Topics: Adolescent; Analgesia, Epidural; Buprenorphine; Butorphanol; Cerebral Palsy; Child; Child, Preschool; Female; Humans; Leg; Male; Morphine; Orthopedics; Pain, Postoperative

The effects of epidural buprenorphine on postoperative respiratory function were studied using respiratory inductive plethysmography (RIP) in two groups of patients [(1) 0.1 mg (2) 0.2 mg] after upper abdominal surgery. Buprenorphine 0.1 mg group showed decreased respiratory rate and increased tidal volume. Decreases in the respiratory rate and the tidal volume were seen in buprenorphine 0.2 mg group and continued for 3-4 hrs after the epidural administration. However, there was no severe respiratory depression in either group. It seems that 0.1 mg of epidural buprenorphine may give a satisfactory postoperative pain relief and less respiratory depression, and RIP is a useful method for the measurement of postoperative respiratory function.

Topics: Abdomen; Buprenorphine; Depression, Chemical; Humans; Injections, Epidural; Pain, Postoperative; Postoperative Period; Respiration; Respiratory Function Tests

Continuous postoperative pain relief produced by epidural block with bupivacaine and buprenorphine was evaluated in 12 patients after thoracotomy, 19 patients after upper abdominal surgery, and 14 patients after lower abdominal surgery. Patients initially received 8 ml of 0.25% bupivacaine and 0.1 mg of buprenorphine at recovery room in operating theater and continuously received the mixture of 0.25% bupivacaine and 5 micrograms.ml-1 buprenorphine at a rate of 1 ml.h-1 using a portable pump. About fifty percent of the patients did not need additional narcotics during 48 postoperative hours. About ninety percent of the patients needed one additional narcotics during 48 postoperative hours. The authors conclude that epidural analgesia with the mixture of bupivacaine and buprenorphine produces satisfactory postoperative pain relief.

Topics: Abdomen; Analgesia, Epidural; Bupivacaine; Buprenorphine; Drug Therapy, Combination; Humans; Pain, Postoperative; Thoracic Surgery

We did a retrospective study on 177 patients after upper and lower abdominal surgery, and compared the efficacy of epidural administration of fentanyl and that of buprenorphine for postoperative pain relief. In fentanyl (F) group, 73 patients received fentanyl 0.1 mg with saline 8 ml epidurally after operation, followed by a constant rate infusion of 0.025 mg.hr-1 for 18-24 hrs. In buprenorphine (B) group, 104 patients, received buprenorphine 0.2 mg with saline 9 ml epidurally. After upper abdominal surgery, 33 patients (76.7%) in F group and 27 patients (52.9%) in B group obtained satisfactory analgesia (P < 0.05). The difference of the degree of analgesia after lower abdominal surgery was not significantly different in both groups. Respiratory depression occurred in 19 patients in B group and 5 patients in F group (P < 0.05). It is concluded that epidural fentanyl delivered by continuous infusion offers a significant advantage compared with epidural buprenorphine for postoperative pain relief following upper abdominal surgery.

Topics: Abdomen; Adult; Aged; Analgesia, Epidural; Buprenorphine; Female; Fentanyl; Humans; Japan; Male; Middle Aged; Pain, Postoperative; Retrospective Studies

Postoperative pain relief with epidural morphine or buprenorphine and intramuscular morphine was investigated in 67 patients undergoing hepatectomy. When the patient first complained of pain after surgery, 1 or 2mg of epidural morphine, or 0.06 mg of epidural buprenorphine given either at T 10-11 or L 3-4, or 0.1 mg/kg of morphine intramuscularly was administered. Lumbar epidural morphine 2mg, as well as thoracic epidural morphine 2mg, produced excellent and long-lasting pain relief. Nine of 12 patients receiving thoracic epidural buprenorphine 0.06 mg were completely pain-free. Thoracic epidural morphine 1 mg and lumbar epidural buprenorphine 0.06 mg produced incomplete analgesia. Analgesic duration of intramuscular morphine tended to be shorter than that of 2 mg of epidural morphine. PaCO2 increased significantly following thoracic epidural morphine 2 mg, although PaCO2 did not change after lumbar epidural morphine 2 mg. No patient had serious side effects. The lumbar epidural administration of 2 mg morphine may be recommended for postoperative analgesia following hepatectomy.

Topics: Adult; Aged; Buprenorphine; Female; Hepatectomy; Humans; Injections, Epidural; Male; Middle Aged; Morphine; Pain, Postoperative

An analgesic is often administered upon the occurrence of pain following surgery. Buprenorphine hydrochloride suppository (0.2 mg) was given immediately postoperatively to patients who had undergone surgery under general anesthesia. Post-operative pain has been observed after 782 +/- 41 minutes (n = 148, mean +/- SE) in the patients with suppository and 127 +/- 18 minutes (n = 57) in the control group (P less than 0.01). Analgesics were given to 68% of the control group within 2 hours, while it was given to 14% of the study group. Further 57% of the latter did not complain of any pain after 20 hours. The pharmacokinetics of buprenorphine was studied in 7 patients. Intrarectal administration of 0.2 mg buprenorphine suppository just after surgery had a sufficient analgesic action and did not induce any adverse reactions of any clinical importance.

Topics: Adult; Aged; Buprenorphine; Drug Evaluation; Female; Humans; Male; Middle Aged; Pain, Postoperative; Suppositories

In an open study, buprenorphine was used as the sole analgesic agent in sixty patients undergoing orthopedic or abdominal surgery. The average dose used was 5 micrograms.kg-1. The level of peroperative analgesia was of good quality and was maintained during the recovery period in the majority of cases. The occurrence of side effects such as nausea, vomiting, respiratory depression was low.

Topics: Abdomen; Adult; Aged; Aged, 80 and over; Analgesia; Buprenorphine; Female; France; Humans; Intraoperative Period; Male; Middle Aged; Orthopedics; Pain, Postoperative; Prospective Studies

Ten patients who underwent surgery (5 right hepatectomy and 5 colectomy) for cancer participated in a clinical controlled study. They were treated with buprenorphine (i.v. slow infusion) to relieve postsurgical pain. We found an increased urinary excretion of this drug in patients who underwent hepatectomy as compared with patients who underwent colectomy. However no differences in the occurrence of side-effects and/or in the therapeutic effect were observed between the two groups. We conclude that buprenorphine can be effectively and safely used also in patients with a resection of liver parenchyma.

Topics: Adenocarcinoma; Adult; Aged; Buprenorphine; Colectomy; Female; Hepatectomy; Humans; Liver Neoplasms; Male; Middle Aged; Pain, Postoperative

The aim of this study of post-nephrectomy acute pain in 30 patients was to compare three methods of postoperative analgesia and determine which one could be the most satisfactory. Ten patients received epidural analgesia with pethidine (400 mg.24 h-1 for 48 hrs). Ten other patients received intrapleural analgesia with bupivacaine (0.2 mg.kg-1.h-1 of 0.5% bupivacaine with 1/200,000 epinephrine). The ten remaining patients received systemic IV analgesia (2 g of propacetamol every 6 hrs and 0.15 mg of buprenorphine every 6 hrs). According to results of pain evaluation score (VAS) epidural analgesia with pethidine (VAS less than 2.5) appeared to be the best tested analgesic method. IV systemic analgesia (VAS less than 5) was less effective. Intrapleural bupivacaine (VAS greater than 5) was ineffective but apparently not toxic (serum concentration less than 1,200 ng.ml-1).

Topics: Acetaminophen; Adult; Analgesia, Epidural; Analgesics; Bupivacaine; Buprenorphine; Drug Administration Schedule; Female; Humans; Injections, Intravenous; Male; Meperidine; Middle Aged; Nephrectomy; Pain, Postoperative; Pleura

In order to control pain during the early post-operative period, patient-controlled analgesia (PCA) with buprenorphine as an analgesic drug was applied in 23 patients undergoing abdominal operations. With this "on demand" system, the patient was allowed to self-administer narcotic analgesic medication using a programmable infusion pump. Overdose could be minimized with a mandatory lock-out interval between allowable injections. Average total requirement of buprenorphine was 0.355 mg at 48 hr after operation. Nineteen of the 23 (82.6%) patients characterized their pain control as "excellent" or "good". In these patients there existed high correlation between the total number of patient attempts and the number of successful injections. The PCA system was thought to provide improved pain relief at smaller total drug dosages. In addition, earlier and greater spontaneous physical activity was maintained with PCA therapy. The potential for overdose could be minimized, and thereby PCA appears to be an efficacious and safe method of providing for postoperative pain relief.

Topics: Abdomen; Adult; Aged; Analgesia, Patient-Controlled; Buprenorphine; Drug Overdose; Evaluation Studies as Topic; Female; Humans; Infusion Pumps; Male; Middle Aged; Pain, Postoperative; Patient Satisfaction

Topics: Analgesia, Epidural; Buprenorphine; Child; Humans; Male; Pain, Postoperative

Topics: Aged; Analgesia, Patient-Controlled; Buprenorphine; Humans; Morphine; Pain, Postoperative

Topics: Buprenorphine; Humans; Pain, Postoperative

Postoperative pain relief with epidural morphine and buprenorphine was studied in 33 patients following hepatectomy. Morphine 2mg or buprenorphine 0.06mg in 10ml of normal saline was administered through an epidural catheter inserted at the Th10-11 or L3-4 interspace. Morphine injected at the lumbar level, as well as that injected at the thoracic level produced excellent and long-lasting (20.8 +/- 8.6 hours) pain relief. Respiratory rate decreased significantly following epidural morphine at the L3-4, but PaCO2 did not change. Buprenorphine injected at the thoracic level produced good and long-lasting (22.6 +/- 9.9 hours) pain relief, although buprenorphine injected at the lumbar level produced incomplete analgesia. The epidural administration of morphine 2mg at L3-4 or buprenorphine 0.06mg at Th10-11 may be recommended for postoperative analgesia following hepatectomy.

Topics: Adult; Aged; Analgesia, Epidural; Buprenorphine; Female; Hepatectomy; Humans; Injections, Epidural; Liver Neoplasms; Male; Middle Aged; Morphine; Pain, Postoperative

Topics: Analgesia, Epidural; Buprenorphine; Dose-Response Relationship, Drug; Humans; Pain, Postoperative

The influence of different lung resection methods on pulmonary function was studied in 34 patients suffering from bronchial carcinoma. Daily measurements from the 1st to 10th postoperative day reveal the greatest losses of function after right upper lobectomy. Lower lobectomies or left upper lobectomy resulted in a less extensive loss of function. Recovery of function mainly occurs in the first 4 days after operation. Centrally acting analgetics are followed by a loss in pulmonary function whereas locally applied analgetics improve early postoperative function.

Topics: Adult; Aged; Airway Resistance; Analgesics; Buprenorphine; Carcinoma, Bronchogenic; Female; Humans; Lung Neoplasms; Lung Volume Measurements; Male; Meperidine; Middle Aged; Nerve Block; Pain, Postoperative; Pneumonectomy; Postoperative Complications; Respiratory Insufficiency

A study conducted on 40 children, aged 1-11 years, who had genito-urinary surgery compared the quality and duration of analgesia after caudal blocks in two groups of patients. Group 1 (n = 20) received caudal bupivacaine 0.25% and group 2 (n = 20) caudal buprenorphine 4 micrograms/kg; each received 0.5 ml/kg body weight. Patients were operated on under general anaesthesia. Postoperative behaviour and severity of pain were measured on a 3-point scale. The results indicate that caudal buprenorphine provides excellent postoperative analgesia in children comparable to caudal bupivacaine in the early postoperative period. Buprenorphine proved better in the late postoperative period. Analgesia lasted from 20 hours to more than 24 hours after caudal buprenorphine with fewer side effects.

Topics: Analgesia; Bupivacaine; Buprenorphine; Child; Child, Preschool; Circumcision, Male; Female; Humans; Hypospadias; Infant; Male; Pain, Postoperative; Time Factors; Urinary Calculi; Urogenital System; Vesicovaginal Fistula

In three groups [(1) intravenous buprenorphine (0.1mg) or (2) fentanyl (100 micrograms.hr-1) and (3) epidural injection of buprenorphine (0.1mg diluted with 10ml normal saline)], we determined the effects of postoperative pain relief in patients after upper abdominal surgery. There are no differences in postoperative analgesia in the three groups, but respiratory depression was seen in some patients who had intravenous buprenorphine or fentanyl. We conclude that epidural injection of buprenorphine is a useful method for postoperative analgesia because of little adverse effect. As respiratory depression caused by buprenorphine was reversed with naloxone, it is not necessary to employ fentanyl instead of buprenorphine.

Topics: Abdomen; Adult; Aged; Analgesia, Epidural; Buprenorphine; Female; Fentanyl; Humans; Injections, Intravenous; Male; Middle Aged; Pain, Postoperative

Analgesic effects were evaluated in patients who received sublingual administration of buprenorphine (0.2mg ampule for injection) as programmed every 8 hours for 3 days following upper abdominal surgery. Patients who received periodic sublingual buprenorphine obtained satisfactory postoperative analgesia and also required less analgesics than those who never received periodic administration of analgesics. Approximately one half of patients who received periodic sublingual buprenorphine required no additional analgesics. Arterial blood-gas analysis showed a significant increase in carbon dioxide tension after sublingual buprenorphine. One patient revealed marked respiratory acidosis after sublingual buprenorphine. These results suggest that periodic sublingual buprenorphine makes up for slow onset in sublingual administration and that it is also effective, convenient, and safe for pain relief after upper abdominal surgery. We, however, should pay attention to the respiratory depression caused by sublingual buprenorphine.

Topics: Abdomen; Administration, Sublingual; Aged; Buprenorphine; Female; Humans; Male; Middle Aged; Pain, Postoperative; Periodicity

The plasma concentrations of buprenorphine were measured and blood gas analysis was done after administration of buprenorphine suppositories (0.2 and 0.4 mg) or its intramuscular injection (0.2mg) in postoperative patients. The C max for 0.4mg suppositories was comparable to that for 0.2mg injection, whereas the T max for suppositories was as large as about 2 hrs in contrast to 1.5 hrs for 0.2mg injection. The size of AUC was in the following order: 0.4mg suppositories greater than 0.2mg injection greater than 0.2mg suppositories. Neither notable increase in PaCO2 nor decrease in respiration rate was observed after administration of the suppositories, indicating that the formulation will not cause clinically significant respiratory depression. No significant changes were observed in blood pressure or pulse rate. Buprenorphine suppositories are considered to be safe for use in postoperative patients. Percent pain relief in the suppository group was smaller than that in the injection group. This appears to be due to a slower rate of increase in the plasma levels of buprenorphine after administration of suppositories than that after intramuscular injection. Therefore, it seems practical to give this drug to postoperative patients before the start of pain.

Topics: Administration, Rectal; Adolescent; Adult; Buprenorphine; Drug Evaluation; Female; Hemodynamics; Humans; Injections, Intramuscular; Male; Middle Aged; Pain, Postoperative; Respiration; Suppositories

The analgesic effect of sublingual buprenorphine 0.4 mg has been compared with pethidine 1 mg/kg given intramuscularly in 80 patients following major gynecologic operation. The results indicate a slower onset of action for sublingual buprenorphine in the first two hours (p less than 0.001), but it has a much longer duration and is more effective for pain relief (p less than 0.001) than pethidine. The main side-effects were nausea and vomiting which occurred after both treatments but with no significant difference.

Topics: Administration, Sublingual; Adult; Buprenorphine; Female; Genital Diseases, Female; Humans; Injections, Intramuscular; Meperidine; Middle Aged; Pain, Postoperative

In a clinical trial buprenorphine (0.3 mg i.v.) was administered, 20-45 minutes before the surgical operation, to 220 women undergoing gynecological surgery. If necessary buprenorphine (0.2-0.3 mg i.m.) was administered also in the post-operative period. By the pre-operatory administration of buprenorphine, a great stability of life parameters was observed during the surgical operation. In the post-operative period most of the patients showed absence of pain or mild pain.

Topics: Analgesia; Anesthesia; Buprenorphine; Female; Genitalia, Female; Humans; Pain, Postoperative; Premedication

Topics: Analgesia; Anti-Anxiety Agents; Benzamides; Benzodiazepines; Buprenorphine; Clomipramine; Drug Synergism; Humans; Morphine; Naproxen; Nordazepam; Pain, Postoperative; Patients; Trazodone

Patient-controlled analgesia (PCA) was studied during the early postoperative period. Subjects were 40 ASA I-III patients recovering from elective major and minor surgery. Buprenorphine doses of 40 micrograms each were available whenever the patients felt pain relief necessary, and were delivered by a microprocessor-controlled injection pump (On-Demand Analgesia Computer). The hourly maximum dose was set at 320 micrograms with a lockout time of 1 minute. A continuous low-dose buprenorphine infusion (5 micrograms/h) was additionally administered in order to prevent catheter obstruction. The duration of the PCA period was 16.9 +/- 5.1 h (mean +/- SD). During this time, 16.1 +/- 11.3 demands per patient were recorded resulting in individual buprenorphine consumptions of 0.63 +/- 0.59 micrograms/kg/h. More buprenorphine was needed following abdominal surgery compared with orthopedic patients, although pain relief was found slightly less in the former group. Buprenorphine consumption was significantly higher in female than in male patients. Overall efficacy and patient acceptance proved to be excellent. The effectiveness of PCA was judged superior by about 93% of patients when compared with previously experienced postoperative analgesia. Side-effects (sweating, nausea, emesis) occurred in about 10% of cases but were usually of minor intensity. No circulatory or respiratory problems were observed during the PCA period.

Topics: Abdomen; Adult; Aged; Buprenorphine; Drug Administration Schedule; Female; Humans; Infusion Pumps; Infusions, Intravenous; Male; Microcomputers; Middle Aged; Orthopedics; Pain, Postoperative

Topics: Aged; Buprenorphine; Evaluation Studies as Topic; Female; Humans; Injections, Epidural; Male; Middle Aged; Pain Measurement; Pain, Postoperative

Topics: Abdomen; Administration, Sublingual; Buprenorphine; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Pain, Postoperative

Topics: Adult; Anesthesia, General; Blood Coagulation Disorders; Blood Platelets; Blood Transfusion; Buprenorphine; Female; Humans; Hysterectomy; Injections, Intramuscular; Pain, Postoperative; Platelet Transfusion; Prostaglandin-Endoperoxide Synthases

Topics: Buprenorphine; Catheterization; Humans; Injections, Epidural; Injections, Intramuscular; Lung; Pain, Postoperative; Thoracotomy; Vital Capacity

The postoperative analgesic efficacy of buprenorphine (Temgesic; R & C Pharmaceuticals) 0.004 mg/kg and morphine 0.15 mg/kg were compared in 60 patients, both agents given by intramuscular injection. According to patients, buprenorphine gave better analgesia. There was no difference in the number of analgesic injections the two groups received in the 24-hour postoperative period. Cardiovascular and respiratory systems were not depressed by either drug. Side-effects were not marked, nausea being the most common in both groups. Morphine had a greater effect on the mood of patients. Buprenorphine proved a satisfactory analgesic for postoperative use by intramuscular injection.

Topics: Adult; Buprenorphine; Humans; Injections, Intramuscular; Morphine; Pain Measurement; Pain, Postoperative

Topics: Adult; Age Factors; Aged; Buprenorphine; Drug Evaluation; Humans; Injections, Epidural; Middle Aged; Pain, Postoperative

Epidural injections of buprenorphine were given for postoperative pain relief to a patient with pulmonary carcinoma who underwent a right upper lobectomy. Paraplegia occurred postoperatively and the patient's neurological status deteriorated after each injection of epidural narcotic. Laminectomies on the third postoperative day revealed an expanded oxidized cellulose (Oxycel) pledget in the epidural space. Neurologic dysfunction after epidural narcotic administration was caused by the oxidized cellulose which had migrated into the epidural space following use for surgical haemostasis and subsequently expanded with the narcotic solution and blood.

Topics: Aged; Buprenorphine; Humans; Injections, Epidural; Lung Neoplasms; Male; Pain, Postoperative; Paraplegia; Postoperative Complications

Topics: Analgesics, Opioid; Buprenorphine; Humans; Morphinans; Pain, Postoperative

The analgesic efficacy and tolerance of a single intramuscular injection of either buprenorphine (0.3 mg) or a buprenorphine (0.3 mg)/naloxone (0.2 mg) combination was compared in 70 patients suffering from moderate to severe pain after abdominal surgery. Patients in both treatment groups experienced good analgesia which was apparent within 10 minutes of administration and lasted for approximately 12 hours. The most frequently reported unwanted effects were drowsiness and/or sleepiness and nausea and/or vomiting which were of mild or moderate severity in most cases. No significant differences were seen between the two treatment groups with regard to the overall assessments of efficacy and tolerance.

Topics: Adult; Aged; Buprenorphine; Drug Combinations; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Morphinans; Naloxone; Pain, Postoperative

Topics: Adult; Aged; Buprenorphine; Female; Humans; Male; Middle Aged; Morphine; Pain, Postoperative

Buprenorphin, 0,3 mg i.v., was used in 20 patients in the age of 51 to 75 years for analgesia after surgery for aortic aneurysm. Haemodynamic parameters of peripheral and pulmonary circulation, cardiac output, as well as blood gases were determined during routine postoperative controlled ventilation. The main results were an initial vasodilation and a decrease in heart rate, both of which reduce myocardial oxygen consumption. This effect is beneficial in the presence of sufficient volume substitution and optimal oxygenation in high-risk patients.

Topics: Aged; Aortic Aneurysm; Blood Pressure; Buprenorphine; Carbon Dioxide; Cardiac Output; Female; Hemodynamics; Humans; Male; Middle Aged; Morphinans; Oxygen; Pain, Postoperative

The effect of sublingual buprenorphine (Temgesic) as a premedicant and for postoperative pain relief compared with morphine/pethidine was studied in 50 patients scheduled for elective surgery of the knee joint. Twenty-five patients received buprenorphine 0.4 mg sublingually 1 h before surgery and the same dose on demand postoperatively. Twenty-five patients were given morphine intramuscularly (7.5 mg or 10 mg to females and males respectively) 1 h preoperatively. This group received pethidine (75 mg) intramuscularly on demand postoperatively. All the patients were anaesthetized with halothane N2O/O2 after induction with thiopentone. No significant differences were found with regard to sedation, dizziness, nausea and vomiting during the study period. Emergence shivering, confusion and restlessness just after termination of the operation were equal in the two groups. In the recovery room, however, there was a higher frequency of shivering (P less than 0.05) in the morphine group. During the first 24 h postoperatively the buprenorphine group was given an average of 3.8 doses compared with 2.3 in the pethidine group (P greater than 0.05). It is concluded, that buprenorphine sublingually is as good as morphine intramuscularly for premedication and therefore should be recommended to patients who wish to avoid injections. For postoperative pain relief the initial dose of buprenorphine should be given intravenously. Only minor and unimportant side effects were seen.

Topics: Administration, Oral; Adult; Buprenorphine; Female; Humans; Hypnotics and Sedatives; Male; Meperidine; Morphinans; Morphine; Orthopedics; Pain, Postoperative; Preanesthetic Medication

Buprenorphine 30 and 40 micrograms/kg was given as the sole intravenous analgesic in balanced anaesthesia to 12 patients undergoing cholecystectomy. Significant and severe respiratory depression was found 15 minutes after preoperative loading with buprenorphine. In the immediate postoperative period six patients were in pain. They were treated with naloxone 0.08-0.4 mg leading to a long lasting period of pain relief (median 22 hours).

Topics: Adult; Anesthesia, Intravenous; Buprenorphine; Depression, Chemical; Humans; Middle Aged; Morphinans; Naloxone; Pain, Postoperative; Prospective Studies; Respiration

Topics: Adult; Buprenorphine; Drug Interactions; Female; Humans; Morphinans; Naloxone; Pain, Postoperative

Using simultaneous measurements of pain in both limbs after bilateral orthopaedic surgery, peripheral and central components of regionally administered drugs can be separated. Perineural local anesthetic action is readily shown in both upper and lower limbs. Perineural morphine had no effect in ankle blocks, although an effect superior to that of local anesthetics has been claimed in man. Similarly, no effect was seen from morphine or buprenorphine given by intravenous regional administration in the upper limbs, although opioids have shown local antinociceptive action in animal models. There is little evidence to suggest that the usual parenteral opioids have any significant peripheral action clinically, but further human studies are needed because of the theoretical importance of even a small peripheral component.

Topics: Analgesics, Opioid; Anesthesia, Conduction; Bupivacaine; Buprenorphine; Female; Humans; Injections, Intravenous; Male; Morphine; Pain, Postoperative

Since buprenorphine has been reported to be effectively analgesic yet free of addiction potential, two single-dose, double-blind, parallel studies were conducted to compare its analgesic activity and safety with those of morphine. The patients in each study consisted of patients experiencing moderate to severe postoperative pain. They were treated with an intramuscular injection of either 0.2 or 0.4 milligram of buprenorphine (Study I) or 0.15 or 0.30 milligram of buprenorphine (Study II) compared with 5.0 or 10.0 milligrams of morphine in both instances. Patients were interviewed prior to drug treatment and at 10, 20 and 30 minutes, and one, two, three, four, five and six hours postdose to determine pain intensity and relief. The degree of sedation, vital signs and side effects were evaluated. Buprenorphine generally appeared comparable to morphine in the onset and duration of action and in side effect liability.

Topics: Adolescent; Adult; Aged; Buprenorphine; Double-Blind Method; Drug Evaluation; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Models, Biological; Morphinans; Morphine; Pain, Postoperative; Random Allocation; Time Factors

Topics: Anesthesia, Epidural; Buprenorphine; Humans; Morphinans; Pain, Postoperative

Topics: Adolescent; Adult; Aged; Buprenorphine; Female; Humans; Male; Middle Aged; Morphinans; Morphine; Pain, Postoperative

Topics: Adolescent; Adult; Aged; Buprenorphine; Humans; Infusions, Parenteral; Male; Middle Aged; Morphinans; Pain, Postoperative; Time Factors

Topics: Adult; Aged; Buprenorphine; Drug Evaluation; Female; Humans; Hysterectomy; Middle Aged; Morphinans; Pain, Postoperative; Pentazocine; Time Factors

Topics: Adult; Buprenorphine; Epidural Space; Female; Humans; Injections; Male; Middle Aged; Morphinans; Morphine; Pain, Postoperative

In a prospective randomized trial, epidural buprenorphine was compared with intramuscular morphine for pain relief after spinal corrective surgery. Both forms of analgesia were given on demand and both produced excellent reduction of pain as assessed with visual linear analogue. The quality and duration of analgesia were similar for both groups of patients. Since the correct placement of epidural catheters could be done intraoperatively in difficult cases and since many patients for spinal corrective surgery have limited respiratory reserve, the authors feel that epidural buprenorphine provides an excellent alternative to conventional opiate analgesia after this type of surgery.

Topics: Adult; Buprenorphine; Epidural Space; Female; Humans; Injections; Injections, Intramuscular; Male; Middle Aged; Morphinans; Morphine; Pain, Postoperative; Prospective Studies; Random Allocation; Spinal Fusion

Postoperative pain relief, consumption of analgesics and the incidence of postoperative complications were investigated in a retrospective cohort-study on 470 patients following abdominal surgery. 221 of these patients received epidural morphine or buprenorphine for postoperative pain relief (Group I). Another group of 249 patients received conventional opiate analgesics intravenously or intramuscularly (Group II). On average the analgesia lasted 14 h after epidural morphine and 11 h after epidural buprenorphine. The overall amount of morphine in the postoperative period was 13.3 +/- 14.9 mg and 0.89 +/- 0.55 mg buprenorphine respectively. 5 cases of pneumonia (2.3%) were seen in the epidural group (Group I). 22 pneumonia cases (8.8%) were registered in the group with conventional analgesics (Group II). Besides the advantage of stronger and longer duration, small dosage and minor central depressive side effects, epidural opiate analgesia has proven to result in positive clinical consequences. The low incidence of postoperative pneumonia is due to the strong regional pain relief, which improves mechanical pulmonary function and gas exchange.

Topics: Adult; Aged; Buprenorphine; Catheterization; Epidural Space; Female; Humans; Injections; Injections, Intramuscular; Injections, Intravenous; Male; Middle Aged; Morphine; Narcotics; Pain, Postoperative

Topics: Buprenorphine; Humans; Morphinans; Pain, Postoperative

In 10 healthy patients, buprenorphine was given as the postoperative analgesic (dosage: peripheral venous injection of 5 microgram/kg BW) after traumatological interventions in the lower extremities, which had been performed under barbiturate-induced halothane anaesthesia. The haemodynamic investigations revealed that buprenorphine has only a minor effect on the high pressure system. In the area of the pulmonary circulation, there was a significant increase in mean pulmonary artery pressure from 15.9 mm Hg to 17.8 mm Hg (+12%), as well as an increase in pulmonary vascular resistance by 16.5%. These changes were most marked 30 to 60 min after the administration of buprenorphine. When 2-3 1 O2/min were administered, none of the patients had PaO2 values of less than 100 mm Hg. 60 min after the injection, the PaCO2 value increased from 33.7 mm Hg to a maximum of 43.9 mm Hg. In 3 patients, PaCO2 increased to more than 45 mm Hg. All patients with greater increases of PaCO2 also evidenced greater increases in the pulmonary vascular resistance. Altogether the haemodynamic changes after buprenorphine administration following halothane anesthesia were not very distinct. In individual cases, however, there were greater increases in PaCO2. The cause of this could involve the additive effects of premedication and anaesthesia medication, and possibly the pain level as well. Both the increase in pulmonary artery pressure and the increase in total pulmonary vascular resistance in these patients were due to hypercapnia (von Euler-Liljestrand mechanism).

Topics: Adolescent; Adult; Anesthesia; Blood Gas Analysis; Buprenorphine; Female; Halothane; Hemodynamics; Humans; Male; Middle Aged; Morphinans; Pain, Postoperative; Respiration

A six-point, incomplete block assay of sublingual buprenorphine and intramuscular morphine has been carried out, providing valid relative potency estimates of the two drugs in terms of total relief on both categorical and visual analog scales. Sublingual buprenorphine was about 15.5 times as potent as intramuscular morphine in terms of these total relief estimates. Similar relative potency estimates were obtained using first-dose-only data. There was no evidence of interaction by day in the crossover data, and the crossover study proved more efficient and provided tighter confidence limits. Sublingual buprenorphine produced a lower peak effect than intramuscular morphine. At equivalent peak effects, it produced longer-lasting analgesia. Side effect occurrence was roughly comparable for the two drugs, and no evidence of narcotic antagonist activity was seen after buprenorphine. The six-point assay proved to be effective in defining the dose-effect curves and relative potencies of the two drugs.

Topics: Administration, Oral; Buprenorphine; Dose-Response Relationship, Drug; Female; Humans; Injections, Intravenous; Male; Morphinans; Morphine; Pain, Postoperative

Topics: Buprenorphine; Humans; Morphinans; Pain, Postoperative

Topics: Analgesics; Buprenorphine; Drug Evaluation; Humans; Morphinans; Morphine; Pain, Postoperative

Topics: Aged; Analgesics; Buprenorphine; Drug Evaluation; Female; Humans; Hypnotics and Sedatives; Infusions, Parenteral; Male; Middle Aged; Morphinans; Pain, Postoperative; Pentazocine; Postoperative Period

Topics: Adult; Analgesics; Blood Gas Analysis; Buprenorphine; Delayed-Action Preparations; Female; Humans; Male; Middle Aged; Morphinans; Pain, Postoperative; Postoperative Period

Buprenorphine was given intravenously to produce analgesia in the immediate postoperative period, the dose being titrated against the response of each patient in order to obtain complete freedom from pain. In 50 patients following lower segment Caesarean section under general anaesthesia, buprenorphine in the dose range 0.4-7.0 mg was found to be a potent, long lasting and safe analgesic. Serial blood gas estimations performed on ten of the patients confirmed the clinically observed lack of respiratory depression.

Topics: Adult; Buprenorphine; Cesarean Section; Dose-Response Relationship, Drug; Female; Humans; Morphinans; Pain, Postoperative; Pregnancy; Respiratory Insufficiency; Time Factors

1 Buprenorphine is a long-acting opiate analgesic. This study was designed to investigate the pharmacokinetics of this drug when given by the sublingual route to ten postoperative patients. Plasma levels of buprenorphine were measured by a specific radioimmunoassay. 2 Plasma levels of the drug following sublingual administration of 0.4 mg showed an apparent delay in absorption and then rose slowly to reach low but significant levels by 3 h. There was considerable variation in the time at which peak levels were achieved. The average systemic availability of the drug by this route was estimated to be 30% by 3 h. 3 Analgesic efficacy and duration of sublingual buprenorphine were assessed using demand analgesia. The analgesia was of about 9 h duration, similar to that achieved by parenteral administration of 0.3 mg of the drug to an equivalent group of patients. The sublingual dose caused a significant fall in the postoperatively elevated group of patients. The sublingual dose caused a significant fall in the postoperatively elevated plasma glucose, and prevented any further rise in plasma cortisol. 4 Reasons for the efficacy of the sublingual route are discussed and it is suggested that this route may be particularly appropriate for highly lipophilic drugs like buprenorphine.

Topics: Analgesia; Blood Glucose; Buprenorphine; Female; Humans; Hydrocortisone; Kinetics; Male; Middle Aged; Morphinans; Pain, Postoperative; Sex Factors; Tongue

Topics: Buprenorphine; Hemodynamics; Humans; Morphinans; Morphine; Pain, Postoperative

Temgesic Injection (buprenorphine), a potent analgesic agent, was given to 240 patients under 18 years of age during a year of monitored release. All but four had the product for the management of moderate or severe pain in the immediate post-operative period. Analgesia was reported as adequate or good in 90% of these young patients when it was assessed 2 and 4 hours after infection. There were no reports of side-effects commonly associated with strong analgesics and particularly antagonist-analgesics such as confusion, hallucination, blurred vision, dry mouth and lightheadedness. There were no serious respiratory or cardiovascular effects. The incidences of other events did not differ from those recorded in the much larger adult population of almost 8,000 patients. Buprenorphine is an effective analgesic suitable for use in the young post-operative patient.

Topics: Adolescent; Adult; Age Factors; Analgesia; Buprenorphine; Child; Child, Preschool; Drug Evaluation; Female; Humans; Injections, Intravenous; Male; Morphinans; Pain, Postoperative

Buprenorphine, a partial opiate-receptor agonist with potent analgesic properties, was given to 7548 patients in the immediate postoperative period. Ninety per cent of patients had good or adequate pain relief for at least 4 hours; there were few adverse effects and the incidence of drug-associated respiratory depression was estimated at less than 1%. There were no other side-effects of clinical note.

Topics: Adolescent; Adult; Aged; Buprenorphine; Child; Child, Preschool; Drug Evaluation; Female; Humans; Male; Middle Aged; Morphinans; Nausea; Pain, Postoperative; Respiratory Insufficiency; Time Factors; Vomiting

Topics: Buprenorphine; Humans; Injections; Morphinans; Pain; Pain, Postoperative

Topics: Buprenorphine; Humans; Infusions, Parenteral; Morphinans; Pain, Postoperative

Sublingual buprenorphine (0.4 mg) and intramuscular papaveretum (20 mg) were compared in sixty patients after abdominal hysterectomy. Though slower in onset of effect the sublingual tablets proved effective for pain relief and appeared to have a longer duration of action. The only side-effects of note were nausea and vomiting which occurred after both treatments. Haloperidol was tried as a long acting antiemetic and appeared successful.

Topics: Adult; Buprenorphine; Double-Blind Method; Evaluation Studies as Topic; Female; Humans; Kinetics; Morphinans; Pain, Postoperative; Papaverine; Random Allocation

The effect of buprenorphine on the cardiovascular system was examined in 11 patients during the period of reduced cardiac reserve after open-heart surgery. Within 10 minutes of giving the full analgesic dose (5 microgram/kg) intravenously the mean heart rate had fallen significantly by six beats/min. Although in two patients the mean arterial pressure fell by 24 mm Hg, there was no overall change in mean arterial pressure, cardiac output, or peripheral resistance. In a further six patients buprenorphine was used successfully as the sole analgesic after open-heart surgery. Buprenorphine appears to be safer than morphine for use in patients with reduced cardiac reserve and is of similar analgesic efficacy.

Topics: Adult; Aged; Blood Pressure; Buprenorphine; Cardiac Surgical Procedures; Heart Rate; Hemodynamics; Humans; Middle Aged; Morphinans; Pain, Postoperative