Sublingual buprenorphine for acute postoperative cancer pain: a retrospective study

Abstract

Background: Sublingual buprenorphine is an atypical opioid that potentially has a wider safety profile than conventional opioids. However, there is a paucity of literature concerning its role in acute postoperative pain. Aim: To describe the use of sublingual buprenorphine including efficacy and safety for the management of acute postoperative pain at a comprehensive cancer centre. Method: A retrospective study of sublingual buprenorphine analgesia after cancer surgery between 1 June 2015 to 31 October 2016. Outcome measures included pain scores (Verbal Numerical Rating Scale), dosage, oral morphine equivalent daily dose before treatment, adverse events, co-analgesia, duration of treatment and length of stay. Patients were categorised as responders or non-responders based on their response. Ethics approved by the Peter MacCallum Cancer Centre Expedited Ethics Review Committee (approval no. 18/59R). Results: Sixty-six patients were included with a mean age of 62.8 years and 53% were male. Of those, 86.3% (55/66) were categorised as responders to sublingual buprenorphine treatment. Pain scores were significantly lower in responders compared to non-responders after treatment 4.2 versus 7.3 (p < 0.05). Sublingual buprenorphine was well tolerated with a low adverse event frequency (10.6%), with nausea/vomiting reported most commonly. All patients were prescribed at least one co-analgesic. The mean duration of treatment was 6.2 days and there was no difference in length of stay between groups. Conclusion: After cancer surgery, patients can benefit from sublingual buprenorphine analgesia due to its safe adverse event profile and overall self-reported efficacy. Further research is recommended to account for confounders including study in a larger cohort.