Efficacy of Intravenous Buprenorphine for Acute Pain in Critically Ill Patients in a Medical Intensive Care Unit

Background: Buprenorphine is an opioid that has recently gained interest for acute pain management in post-operative patients. It has theoretical advantages due to its unique mechanism and favorable adverse effect profile. Currently, no studies have evaluated intravenous buprenorphine for acute pain management in a critically ill medical patient population. Objective: The objective of this study was to compare the use of intravenous buprenorphine with or without a full agonist IV opioid vs a full agonist IV opioid alone for acute pain in non-ventilated, non-surgical critically ill patients. Methods: A retrospective cohort study was completed of patients who received IV buprenorphine or full-agonist opioids while admitted to the medical intensive care unit at an academic medical center and community hospital. Results: The median DVPRS difference in the buprenorphine group compared to the control group was 5 vs 6. The non-inferiority t-test showed buprenorphine was not significantly non-inferior with mean DVPRS score at day 3 for the buprenorphine group was 5.02 and the control group was 5.07 ( P = 0.85). Respiratory depression within 7 days occurred less in the buprenorphine group (20.6% vs 42.9%, P = 0.004). Oversedation occurred less in the buprenorphine group (27% vs 46.8%, P = 0.01. The ICU LOS was longer in the buprenorphine group (8 vs 5 days, P = 0.01). The median daily OME on day 1 was less in the buprenorphine group (29 vs 42.5, P = 0.03). Conclusion: Intravenous buprenorphine may be a comparable alternative to full agonist intravenous opioids for pain control in the medical intensive care unit.