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Sublingual buprenorphine effective for acute fracture pain

Reuters Health • The Doctor's Channel Daily NewscastReuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – For adult patients seen in the emergency department with acute bone fracture, a sublingual dose of buprenorphine is as effective as intravenous morphine in relieving pain, an Iranian team reports in the Annals of Emergency Medicine online November 25.

“Because sublingual dosing allows for easier and quicker administration, buprenorphine appears to be a promising alternative to intravenous morphine for acute pain management,” the authors conclude.

Dr. Mohammad Jalili, with Imam Hospital and the Tehran University of Medical Sciences, and colleagues note that easily administered analgesic drugs would be ideal for use in busy emergency departments. The opioid receptor agonist-antagonist buprenorphine is readily absorbed sublingually, and has an analgesic potency up to 40 times greater than morphine sulfate.

They therefore conducted a double-blind, double-dummy, randomized trial of 0.4 mg sublingual buprenorphine versus 5 mg IV morphine in 99 adults with bone fracture seen in their institution’s emergency department.

On a 0 – 10 pain scale, median pain scores initially were 8 in both the buprenorphine and morphine groups. Median scores were 5 at 30 minutes after administration and 2 at 60 minutes in both arms, the team found.

Adverse effects at 30 minutes were also similar with both treatments, according to the report. Rates of nausea were 14% with buprenorphine and 12% with morphine, and corresponding rates of dizziness were 14% versus 22%.

Hypotension was more common with morphine (18%) than buprenorphine (4%), but this was readily reversible with IV fluids, Dr. Jalili and colleagues report.

“Effective equivalence between the 2 regimens can be concluded,” they write. “We observed no serious or persistent adverse effects with either drug.”

However, they caution that because patients with chronic respiratory problems or heart failure were excluded from the study, the results may not be generalizable to older patients.


Sublingual Buprenorphine in Acute Pain Management: A Double-Blind Randomized Clinical Trial

Ann Emerg Med. 2011;