Sublingual buprenorphine versus intravenous or intramuscular morphine in acute pain: A systematic review and meta-analysis of randomized control trials

• Published in: The American journal of emergency medicine Vol. 37; no. 3; p. 381
• Main Authors: Vlok, Ruan, An, Gun Hee, Binks, Matthew, Melhuish, Thomas, White, Leigh
• Format: Journal Article
• Language: English
• Published: Philadelphia Elsevier Limited 01.03.2019
• Subjects: Abdominal surgery; Analgesia; Analgesics; Anesthesia; Bias; Buprenorphine; Cholecystectomy; Clinical trials; Collaboration; Data processing; Drug overdose; Emergency medical care; Evidence-based medicine; Hypotension; Intravenous administration; Meta-analysis; Morphine; Narcotics; Nausea; Pain; Pain perception; Pruritus; Quality; Randomization; Systematic review; Vomiting
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2018.05.052

IntroBuprenorphine is a potent analgesic agent with several unique and favourable features such as its sublingual formulation. The aim of this study is to compare the effectiveness of sublingual versus intramuscular and intravenous buprenorphine in acute pain.MethodsFive major databases were systematically searched until April 2018. All randomized control trials comparing sublingual buprenorphine with intravenous or intramuscular morphine in acute pain were included in this review. These studies were assessed for level of evidence and risk of bias. The data was then analyzed both qualitatively and where appropriate by meta-analysis. The primary outcomes were analgesic effect up to six hours and rescue analgesia requirement. The secondary outcomes were incidence of respiratory depression, nausea, vomiting, dizziness and hypotension.ResultsNine studies comparing sublingual and intramuscular or intravenous buprenorphine were identified and included 826 patients. There was no difference in pain at any time point before six hours or need for rescue analgesia between the two agents. There was no difference in secondary outcomes between the two agents.DiscussionSublingual buprenorphine offers an effective alternative to intravenous or intramuscular analgesia in acute pain. Sublingual buprenorphine appears to be a viable option in patients where intravenous access is difficult or not favourable.