Buprenorphine analgesia: Impacts on opioid burden and clinical trajectory in acute trauma care.

IF 3.9 2区医学 Q2 CRITICAL CARE MEDICINE

Journal of Trauma and Acute Care Surgery Pub Date : 2026-11-01 Epub Date: 2026-06-12 DOI:10.1097/TA.0000000000005084

Sabri Conde-Yassin, Jacob Gillen, Josh Stodghill, Michael Collins, Katie Bower, Emily Faulks, Bryan Collier

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引用次数: 0

Abstract

Background: Schedule II opioids are widely used for trauma analgesia but carry dose-dependent risks of respiratory depression, tolerance, hyperalgesia, and addiction. Buprenorphine, a Schedule III opioid, is a potent analgesic with a more favorable safety profile; however, its integration into trauma care remains uncharacterized.

Methods: A single-center observational study included adult trauma patients admitted to a Level I trauma center from January 2021 to June 2024. The trauma service formalized buprenorphine analgesia in June 2023. Outcomes were assessed by (1) an unadjusted pre/post June 2023 analysis (pre-BΔ vs. post-BΔ) and (2) a 1:1 nearest-neighbor propensity score-matched comparison of post-BΔ patients who received (Bup + ) or did not receive (Bup - ) buprenorphine. Bup + and Bup - groups were matched by demographics and injury characteristics. Sublingual/buccal and parenteral buprenorphine were assigned morphine milligram equivalents (MME) conversion factors of 30 and 100, respectively. Incidence rate ratios (IRRs) with 95% CI were calculated; significance was set at p <0.05.

Results: Unadjusted analysis included 3,935 patients (2,777 pre-BΔ; 1,158 post-BΔ). Increased buprenorphine use was associated with reduced MME (median, 138 pre-BΔ vs. 75 post-BΔ; p < 0.001; IRR, 0.70; 95% CI, 0.69-0.71), lower intensive care unit (ICU) admission rates (IRR, 0.78; 95% CI, 0.73-0.83), and shortened ICU length of stay (IRR, 0.87; 95% CI, 0.80-0.94). In the matched post-BΔ cohort (n = 544) buprenorphine use was associated with lower ICU admission (IRR, 0.63; 95% CI, 0.54-0.73) and shorter ICU length of stay (IRR, 0.67; 95% CI, 0.59-0.75); median MME did not differ (114 vs. 91, p = 0.187), though IRR analyses demonstrated lower opioid exposure (IRR, 0.82; 95% CI, 0.81-0.83). Across analyses, no differences were observed in survival or adverse events.

Conclusions: In trauma patients, Schedule III buprenorphine analgesia was associated with reduced inpatient opioid exposure and ICU escalation. Further validation may establish buprenorphine as an advance in opioid stewardship for vulnerable trauma populations.

Level of evidence: Therapeutic/Care Management; Level III.

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丁丙诺啡镇痛：对急性创伤护理中阿片类药物负担和临床轨迹的影响。

背景：附表II阿片类药物广泛用于创伤镇痛，但存在呼吸抑制、耐受性、痛觉过敏和成瘾的剂量依赖性风险。附表III阿片类药物丁丙诺啡是一种强效镇痛药，具有更有利的安全性；然而，它与创伤护理的结合仍然是未知的。方法：一项单中心观察性研究纳入了2021年1月至2024年6月在一级创伤中心住院的成人创伤患者。创伤科于2023年6月正式启用丁丙诺啡镇痛。通过(1)未经调整的2023年6月前后分析（pre-BΔ vs. post-BΔ）和(2)接受（Bup+）或未接受（Bup-）丁丙诺啡的post-BΔ患者的1:1近邻倾向评分匹配比较来评估结果。Bup+组和Bup-组根据人口统计学和损伤特征进行匹配。舌下/口腔丁丙诺啡和肠外丁丙诺啡的吗啡毫克当量（MME）转换因子分别为30和100。计算95% CI的发病率比（IRRs）；结果：未经调整的分析包括3935例患者（2777例pre-BΔ； 1158例post-BΔ）。丁丙诺啡使用增加与MME降低（中位数，138 pre-BΔ vs. 75 post-BΔ； p < 0.001； IRR, 0.70; 95% CI, 0.69-0.71）、重症监护病房（ICU）入院率降低（IRR, 0.78; 95% CI, 0.73-0.83）和ICU住院时间缩短（IRR, 0.87; 95% CI, 0.80-0.94）相关。在匹配的post-BΔ队列（n = 544）中，丁丙诺啡的使用与较低的ICU住院率（IRR, 0.63; 95% CI, 0.54-0.73）和较短的ICU住院时间（IRR, 0.67; 95% CI, 0.59-0.75）相关；中位MME没有差异（114比91，p = 0.187），尽管IRR分析显示阿片类药物暴露更低（IRR, 0.82; 95% CI, 0.81-0.83）。在整个分析中，没有观察到生存或不良事件的差异。结论：在创伤患者中，附表III丁丙诺啡镇痛与减少住院阿片类药物暴露和ICU升级相关。进一步的验证可能会将丁丙诺啡作为阿片类药物管理的进展，用于脆弱的创伤人群。[J] .创伤急症护理外科杂志[J]; 2011；版权所有©2026威科集团健康有限公司版权所有)。证据水平：治疗/护理管理；第三层次。

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来源期刊

Journal of Trauma and Acute Care Surgery 医学-外科

CiteScore

6.00

自引率

11.80%

发文量

637

审稿时长

2.7 months

期刊介绍： The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.