Buprenorphine Enhances and Prolongs the Postoperative Analgesic Effect of Bupivacaine in Patients Receiving Infragluteal Sciatic Nerve Block

• Published in: Anesthesiology (Philadelphia) Vol. 113; no. 6; pp. 1419 - 1426
• Main Authors: CANDIDO, Kenneth D, HENNES, Jason, GONZALEZ, Sergio, MIKAT-STEVENS, Marianne, PINZUR, Michael, VASIC, Vladimir, KNEZEVIC, Nebojsa Nick
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-12-2010
• Subjects: Adult; Ambulatory Surgical Procedures; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local; Ankle - surgery; Biological and medical sciences; Bupivacaine; Buprenorphine - administration & dosage; Buprenorphine - therapeutic use; Double-Blind Method; Female; Foot - surgery; Humans; Injections, Intramuscular; Male; Medical sciences; Middle Aged; Nerve Block; Orthopedic Procedures; Pain Measurement; Pain, Postoperative - drug therapy; Patient Satisfaction; Postoperative Nausea and Vomiting - epidemiology; Preanesthetic Medication; Sciatic Nerve; Treatment Outcome; Local anesthetic; Human; Postoperative; Bupivacaine; Buprenorphine; Carboxamide; Opiates; Anesthesia; Organic amide; Narcotic analgesic; Anilide
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/ALN.0b013e3181f90ce8

Results from previous studies have shown favorable effects from the addition of buprenorphine to local anesthetics used for interscalene or axillary perivascular brachial plexus blocks. The main objective of the current study was to determine whether addition of buprenorphine could enhance bupivacaine analgesia after infragluteal sciatic nerve block.
One hundred and three consenting adult patients for elective foot and ankle outpatient surgeries were prospectively assigned randomly, in double-blind fashion, to one of three groups. Group 1 received 0.5% bupivacaine with epinephrine 1:200,000 for infragluteal sciatic block plus 1 ml normal saline intramuscularly. Group 2 received bupivacaine sciatic block along with intramuscular buprenorphine (0.3 mg). Group 3 received bupivacaine plus buprenorphine for infragluteal sciatic block and 1 ml normal saline intramuscularly.
Although patients receiving buprenorphine either for sciatic block or intramuscularly had less pain in the postanesthesia care unit compared with patients receiving only bupivacaine, the individual pair-wise comparison of the analysis of variance model showed no statistical difference. However, only buprenorphine added to bupivacaine for sciatic block prolonged postoperative analgesia. Patients receiving a combination of buprenorphine and bupivacaine for sciatic block had lower numeric rating pain scores and received less opioid medication at home than patients in the other two groups.
The results show that buprenorphine may enhance and prolong the analgesic effect of bupivacaine when used for sciatic nerve blocks in patients undergoing foot and ankle surgery under general anesthesia but does not do so to the extent shown in previous studies using brachial plexus models with mepivacaine and tetracaine.