buprenorphine and Postoperative-Nausea-and-Vomiting

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 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

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

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

Simultaneous use of opioids with a different pharmacological profile may lead to unexpected prolongation of effects. In an open label study possible overhang in post-operative respiratory effects and vigilance was determined in a group of patients (n = 22) carrying a transdermal buprenorphine patch for at least 2 months for treatment of chronic pain, undergoing a fentanyl-based fast-track enflurane anesthetic technique for open-heart operation. Data was compared with another randomised group (n = 21) undergoing similar open-heart procedures with no other opioid than fentanyl on board.. Following induction with fentanyl and a barbiturate, depth of anesthesia with enflurane (Fi 0.5) was guided using the bispectral index (BIS). Additional doses of fentanyl were given when blood pressure and/or heart-rate increased 20% above pre-induction levels. Early postoperative extubation was initiated once the cardiovascular system was stable and there were no signs of respiratory impairment. Following a similar time of operation and anesthesia and a similar total dose of fentanyl (0.69 mg +/- 0.23 SD versus 0.67 mg +/- 0.16 SD), postoperatively, there were no significant differences between the buprenorphine- and the control group regarding the time till extubation (25.2 min +/- 6.1 versus 33.3 min +/- 5.0) and the arterial blood gases under oxygen inhalation (paO2 136 torr +/- 48 SD versus 128 torr +/- 35 SD; paCO2 43.3 torr +/- 3.3 SD versus 41.9 torr +/- 1.2 SD and the post-anesthetic vigilance and recovery score (6.8 +/- 1.0 versus 7.5 +/- 0.8) 60 minutes after end of anesthesia. Contrary to the control group, there was a lower and significant (p < 0.01) incidence of PONV in patients with transdermal buprenorphine.. Patients using a buprenorphine patch for the relief of chronic pain cannot be regarded as opioid naïve. Due to adaptive mechanisms and the development of tolerance, there is no prolongation of the respiratory depression induced by intraoperative fentanyl. Long-term use of transdermal buprenorphine does not lead to potentiation or prolongation of opioid effects in cardiac surgery patients.

Topics: Administration, Cutaneous; Aged; Analgesics, Opioid; Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Barbiturates; Blood Gas Analysis; Blood Pressure; Buprenorphine; Cardiac Surgical Procedures; Drug Synergism; Electroencephalography; Female; Fentanyl; Heart Rate; Humans; Isoflurane; Male; Middle Aged; Postoperative Nausea and Vomiting

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

This randomized double-blind trial was designed to evaluate the antiemetic effect of continuous epidural analgesia with droperidol mixed with bupivacaine and buprenorphine. We studied 78 patients for abdominal gynecological surgery under general-epidural anesthesia. After recovery from anesthesia, they received epidural administration of 0.25% bupivacaine 40 ml and buprenorphine 0.4 mg with or without droperidol 2.5-5.0 mg at a rate of 2 ml.h-1 for 24 hours. The addition of droperidol 5.0 mg led to serious undesirable effects. Droperidol 2.5 mg, however, showed not only significant antiemetic effect without any adverse action, but also the reduction of rescue analgesics. We conclude that the addition of a small dose of droperidol to epidural analgesics reduces the incidence of postoperative emesis and the requirement of rescue analgesics.

Topics: Adult; Aged; Analgesia, Epidural; Antiemetics; Bupivacaine; Buprenorphine; Dose-Response Relationship, Drug; Double-Blind Method; Droperidol; Drug Synergism; Humans; Middle Aged; Postoperative Nausea and Vomiting; Prospective Studies

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

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

When we make reference to the quality of anesthesia, we consider three points, early emergence, postoperative pain relief, and postoperative nausea and vomiting (PONV). Among these, PONV is comparatively neglected. Many analgesics used during anesthesia may cause PONV.. The incidence of PONV was assessed in 100 surgical patients who had received balanced anesthesia. Anesthesia was induced with propofol, ketamine, midazolam and buprenorphine (Group P), or butorphanol (Group T), and vecuronium was given to facilitate tracheal intubation. The patients received balanced anesthesia with infusion of propofol, ketamine, vecuronium, and either buprenorphine (Group P) or butorphanol (Group T), with nitrous oxide. PONV was recorded for 24 hours postoperatively.. Incidences of nausea were 27.1% in Group P and 15.8% in Group T (NS). Incidences of vomiting were 12.5% in Group P and 5.3% in Group T (NS). However, a high incidence of PONV was found in female (42.2%) vs. male (6.2%) (P < 0.01) and in over 25 BMI group (34.5%) vs. under 25 BMI group (15.5%) (P < 0.05).. The type of analgesics used during balanced anesthesia is not important for development of PONV, but patient's factors, such as gender and BMI, are more closely associated with PONV.

Topics: Aged; Analgesics, Opioid; Anesthesia; Body Mass Index; Buprenorphine; Butorphanol; Female; Humans; Incidence; Male; Middle Aged; Postoperative Nausea and Vomiting; Sex 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