In critically ill patients, sublingual buprenorphine was as effective as oral or enteral oxycodone in terms of pain control and opioid consumption, according to a retrospective, parallel, cohort study. “Buprenorphine sublingual is an appropriate option for patients in the ICU who are unable to take oral/enteral medications,” the authors conclude.
In a Sydney, Australia, quaternary hospital, all patients admitted to 2 general medical or surgical ICUs from Jan. 2019 to Jan. 2023 were grouped based on receipt of sublingual buprenorphine or oral/enteral oxycodone. “Pain control was compared between a propensity score matched cohort of patients who received buprenorphine versus oxycodone. The primary outcome was the probability of significant pain. A significant pain score was defined as greater than or equal to 4 on the 0–10 Numeric Rating Scale or greater than or equal to 6 on the Behavioral Pain Scale. The study cohort included 1,070 patients (288 buprenorphine and 782 oxycodone). After propensity score matching, there were 288 patients in each group. The mean age of the matched cohort was 64 ± 16 years, 295 (51%) were male, and 359 (62%) had a surgical admission. The median probability of significant pain was 0.16 with buprenorphine and 0.17 with oxycodone (median difference, 0.01; 95% CI, –0.02 to 0.04; P = 0.50). Median opioid consumption in oral morphine milligram equivalents (MMEs) was 65 with buprenorphine and 70 with oxycodone (median difference, –1 mg; 95% CI, –10 to 10 mg; P = 0.73). Median MME per ICU day was 22 with buprenorphine and 22 with oxycodone (median difference, 1 mg; 95% CI, –2 to 5 mg; P = 0.38).”