Comparison of Intravenous Morphine with Sublingual Buprenorphine in Management of Postoperative Pain after Closed Reduction Orthopedic Surgery

Document Type : RESEARCH PAPER


1 Cardiac Anesthesia Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Mashhad University of Medical Sciences, Faculty of Medicine, Mashhad, Iran


Background: Postoperative pain is a common side effect following surgery that can significantly reduce surgical quality and patient’s satisfaction. Treatment options are morphine and buprenorphine. We aimed to compare the efficacy of a single dose of intravenous morphine with sublingual buprenorphine in postoperative pain control following closed reduction surgery.
Methods: This triple blind clinical trial was conducted on 90 patients referred for closed reduction orthopedic surgery. They were older than 18 years and in classes I and II of the American Society of Anesthesiologists (ASA) with an operation time of 30-90 minutes. Patients were divided into two groups of buprenorphine (4.5μg/kg sublingually) and morphine (0.2mg/kg intravenously). Baseline characteristics, vital signs, pain score, level of sedation and pharmacological side effects were recorded in the recovery room (at 0 and 30 minutes), and in the ward (at 3, 6 and 12 hours). SPSS version 19 software was used for data analysis and the significance level was set at P
Results: Ninety patients were studied, 60 males and 30 females with a mean age of 37.7±16.2 years. There was no significant difference between the two groups in terms of baseline characteristics.Pain score in the morphine group was significantly higher than the buprenorphine group with an average score of 2.5 (P<0.001). Postoperative mean heart rate in the buprenorphine group was four beats lower than the morphine group (P<0.001). Also, in the buprenorphine 48.6% and in the morphine group 86.7% of cases were conscious in recovery (P=0.001) with a higher rate of pruritus in the latter group (P=0.001).
Conclusion: Sublingual buprenorphine administration before anesthesia induction in closed reduction surgery can lead to better postoperative pain control in comparison to intravenous morphine. Due to simple usage and longer postoperative sedation, sublingual buprenorphine is recommended as a suitable drug in closed reduction surgery.


  1. Perkins FM, Kehlet H. Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology. 2000; 93(4):1123-33.
  2. Wu CL, Fleisher LA. Outcomes research in regional anesthesia and analgesia. Anesth Analg. 2000; 91(5):1232-42.
  3. Maunuksela EL, Korpela R, Olkkola KT. Comparison of buprenorphine with morphine in the treatment of postoperative pain in children. Anesth Analg. 1988; 67(3):233-9.
  4. Sarton E, Olofsen E, Romberg R, den Hartigh J, Kest B, Nieuwenhuijs D, et al. Sex differences in morphine analgesia: An experimental study in healthy volunteers. Anesthesiology. 2000; 93(5):1245-54.
  5. Kaziuhiko F. Opioids. In: Miller RD, Eriksson LI. editors. Miller’s Anesthesia. 7th ed. Philadelphia: Churchill Livingstone; 2010.
  6. Hurley RW, Wu CL. Acute Postoperative Pain. In: Miller RD, Eriksson LI. editors. Miller’s Anesthesia. 7th ed. Philadelphia: Churchill Livingstone; 2010.
  7. Moa G, Zetterström H. Sublingual buprenorphine as postoperative analgesic: a double-blind comparison with pethidine. Acta Anaesthesiol Scand. 1990; 34(1):68-71.
  8. Oifa S, Sydoruk T, White I, Ekstein MP, Marouani N, Chazan S, et al. Effects of intravenous patient-controlled analgesia with buprenorphine and morphine alone and in combination during the first 12 postoperative hours: a randomized, double-blind, four-arm trial in adults undergoing abdominal surgery. Clin Ther. 2009; 31(3):527-41.
  9. van den Berg AA, Honjol NM, Prabhu NV, Datta S, Rozario CJ, Muraleedaran R, et al. Analgesics and ENT surgery. A clinical comparison of the intraoperative, recovery andpostoperative effects of buprenorphine, diclofenac, fentanyl, morphine, nalbuphine, pethidineand placebo given intravenously with induction of anaesthesia. Br J Clin Pharmacol. 1994; 38(6):533-43.
  10. Risbo A, Chraemmer Jørgensen B, Kolby P, Pedersen J, Schmidt JF. Sublingual buprenorphine for premedication and postoperative pain relief in orthopaedic surgery. Acta Anaesthesiol Scand. 1985; 29(2):180-2.
  11. Brodbelt DC, Taylor PM, Stanway GW. A comparison of preoperative morphine and buprenorphine for postoperative analgesia forarthrotomy in dogs. J Vet Pharmacol Ther. 1997; 20(4):284-9.
  12. Gaitini L, Moskovitz B, Katz E, Vaisberg A, Vaida S, Nativ O. Sublingual buprenorphine compared to morphine delivered by a patient-controlled analgesia system as postoperative analgesia after prostatectomy. Urol Int. 1996; 57(4):227-9.
  13. Capogna G, Celleno D, Sebastiani M, Costantino P, Reggio S. [Continuous intravenous infusion with patient-controlled anesthesia for postoperative analgesia in cesarean section: morphine versus buprenorphine]. Minerva Anestesiol. 1989; 55(1-2):33-8.
  14. Bradley JP. A comparison of morphine and buprenorphine for analgesia after abdominal surgery. Anaesth Intensive Care. 1984; 12(4):303-10.
  15. Dingus DJ, Sherman JC, Rogers DA, DiPiro JT, May R, Bowden TA Jr. Buprenorphine versus morphine for patient-controlled analgesia after cholecystectomy. Surg Gynecol Obstet. 1993; 177(1):1-6.