BACKGROUND: Opioids remain in common use for postoperative pain management after orthopedic surgery. Buprenorphine (BUP) is a partial agonist opioid best known as a lifesaving medication for opioid use disorder. Although extensively studied for acute pain management with at least the efficacy as full agonist opioids (FAO) and a superior safety profile, it is rarely used for this purpose in contemporary practice.

OBJECTIVES: To assess feasibility of inpatient administration of buccal BUP, in addition to usual analgesic care, and conduct an exploratory analysis of pain outcomes in an orthopedic surgery population, including a subset who received twice-daily buccal BUP.

STUDY DESIGN: Retrospective cohort.

SETTING: Veterans Health Administration.

METHODS: A cohort of patients were treated with buccal BUP perioperatively at the discretion of the anesthesiologist. We subsequently undertook a retrospective chart review of 35 recent orthopedic cases at our institution over several months, including the subset who received buccal BUP, aiming to assess the feasibility of its use and make a preliminary assessment of pain outcomes.

RESULTS: Our review found that perioperative buccal BUP was feasible within a population of largely opioid-naïve patients undergoing major orthopedic surgery. Pain outcomes were similar between the groups receiving BUP, in addition to usual care, and those not receiving BUP in addition to usual care.

LIMITATIONS: This is a retrospective review and lacks a randomization process and size to address bias and confounding. The largely homogenous patient population further limits generalizability. As such, no conclusions, generalizable or otherwise, should be made about any of the observed results.

CONCLUSIONS: To our knowledge, the buccal formulation of BUP, which received US Food and Drug Administration approval for chronic pain management in 2015, has not been studied for acute pain management. In a population undergoing total joint arthroplasty, buccal BUP was readily accepted by patients and nursing staff, resulted in pain and opioid consumption outcomes similar to the usual care, was compatible with FAO, and resulted in no safety concerns. Given its expected safety advantages over FAO, BUP deserves further consideration and study as an opioid analgesic within a multimodal analgesic regimen.

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