BACKGROUND: Opioids are widely used in the management of acute postoperative pain after thoracic surgery. Buprenorphine (BUP), though discovered as an analgesic, with robust evidence supporting its efficacy for this purpose, and possessing important safety advantages compared with commonly used full agonist opioids, is currently rarely used for acute pain management.

OBJECTIVES: To assess feasibility of implementing buccal BUP as part of a multimodal analgesia strategy, and to conduct an exploratory comparison of pain outcomes between patients receiving buccal BUP in addition to standard postoperative pain management, and patients receiving standard postoperative pain management alone.

STUDY DESIGN: Retrospective cohort.

SETTING: Veterans Health Administration.

METHODS: In this single-center, retrospective cohort study of patients undergoing minimally invasive lung surgery, we assessed feasibility of buccal BUP administration for perioperative pain management, and conducted an exploratory analysis of pain outcomes in 29 patients, a subset of which received perioperative buccal BUP.

RESULTS: Buccal BUP is feasible, safe, and is associated with improved pain outcomes after thoracic surgery.

LIMITATIONS: This retrospective review within a relatively homogenous population lacks a randomization process and size to address bias and confounding. Further study is needed to confirm any identified associations. We did not assess long-term outcomes, such as function and persistent opioid use.

CONCLUSIONS: We are not aware of prior study of the buccal formulation of BUP for acute pain management. In this retrospective cohort study of largely opioid-naive patients undergoing thoracic surgery, buccal BUP was feasible, safe, and was associated with reduced pain postoperatively.

KEYWORDS: Buprenorphine, acute pain, belbuca, buccal, opioid analgesia, postoperative pain