RESEARCH SUMMARY

No Added Pain Relief Benefit with Buprenorphine Patches after Arthroscopic Rotator Cuff Repair

Anthony Calabro, MA

Key Highlights

  • Buprenorphine patches did not improve postoperative pain or joint function recovery.
  • No clinically important differences were observed in numeric pain or ASES function scores.
  • Dizziness, drowsiness, and nausea occurred less frequently in the buprenorphine group.

The use of buprenorphine patches in patients undergoing arthroscopic rotator cuff repair offered no clinically meaningful improvements in pain relief or shoulder joint function compared with an oral regimen of tramadol and celecoxib, according to the results of a randomized controlled trial published in Clinical Orthopaedics and Related Research.

Although the experimental group experienced a lower incidence of postoperative nausea and sedation, the investigators concluded that the benefits were too minor to justify a change in standard postoperative analgesia.

Transdermal buprenorphine patches, commonly used in other postoperative settings, have been hypothesized to reduce systemic side effects while providing sustained analgesia. However, little direct comparative data exist regarding their use in shoulder arthroscopy, making this trial a timely contribution to the evidence base.

This prospective, single-center randomized controlled trial included 72 patients with partial- or full-thickness rotator cuff tears less than 3 cm in size. Eligible patients were randomized to either a control group receiving 100 mg tramadol plus 200 mg celecoxib every 12 hours for 2 weeks postoperatively, or an experimental group treated with transdermal buprenorphine patches initiated 48 hours before surgery. A medication journal monitored patient compliance. Key outcomes included numeric rating scale (NRS) pain scores at rest and with movement, American Shoulder and Elbow Surgeons (ASES) scores for shoulder function, and incidence of adverse events. Minimum clinically important differences (MCID) were defined as 2 points on the NRS and 15 points on the ASES score.

The researchers observed no clinically important differences between groups in either NRS pain scores or ASES scores at any postoperative time point. Mean scores in both groups fell below the MCID thresholds for improvement. However, transient side effects such as dizziness or drowsiness (20% in the buprenorphine group vs 44% in the control group; P = .04) and nausea (10% vs 34%, respectively; P = .02) occurred less frequently among patients using buprenorphine patches during the hospital stay.

“In this randomized trial, we found no clinically important advantages in pain or function to the use of buprenorphine patches after arthroscopic rotator cuff repair, and insufficient evidence exists to confirm whether the minor differences in transient side effects could justify the use of a new and largely untested analgesic approach in this context,” the authors concluded. “That being so, we recommend against the routine use of buprenorphine patches for this indication. In general, we found that pain levels were low after the procedure in both groups. Future studies, therefore, should focus on the efficacy of buprenorphine patches for more invasive or more painful procedures.”

Reference
Liu W, Qin J, Fang X, et al. Is the use of a buprenorphine transdermal patch more effective than oral medications for postoperative analgesia after arthroscopic rotator cuff repair? a randomized clinical trial. Clin Orthop Relat Res. 2025;483(5):857-865. doi:10.1097/CORR.0000000000003303