Buprenorphine a viable option for acute pain in ICU patients

The use of intravenous (IV) buprenorphine appears to be a good substitute for full agonist IV opioids for managing pain in the medical intensive care unit (ICU), suggests a study.

This retrospective cohort study included patients who received IV buprenorphine or full agonist opioids (control) while admitted to the medical ICU at an academic medical centre and community hospital.

Patients in the buprenorphine group had a comparable Defense and Veterans Pain Rating Scale (DVPRS) to those in the control group (median DVPRS, 5 vs 6). In the noninferiority t-test, buprenorphine demonstrated its noninferiority to full agonist opioid, with a mean DVPRS score at day 3 of 5.02 compared with 5.07 for the control treatment (p=0.86).

Furthermore, patients exposed to IV buprenorphine were less likely to develop respiratory depression within 7 days (20.6 percent vs 42.9 percent; p=0.004) or to experience oversedation (27.0 percent vs 46.8 percent; p=0.01) than those who received full agonist opioids.

However, the buprenorphine group had a longer ICU length of stay than the control group (8 vs 5 days; p=0.01). The median daily oral morphine equivalent on day 1 was also less in patients who received buprenorphine (29.0 vs 42.5; p=0.03).

“Buprenorphine is an opioid that has recently gained interest for acute pain management in postoperative patients,” the researchers said. “It has theoretical advantages due to its unique mechanism and favourable adverse effect profile.”