Meta-analysis of 58 randomized trials involving 2,587 patients reveals buprenorphine delivers superior pain relief compared to traditional full-agonist opioids following surgery. The partial opioid agonist reduced pain intensity scores by a standardized mean difference of 0.34 points and cut rescue medication needs by 60% versus morphine, fentanyl, and other conventional opioids.
This finding challenges current post-surgical pain protocols that typically rely on full mu-opioid receptor agonists. Buprenorphine's partial agonism creates a "ceiling effect" that may reduce respiratory depression risk while maintaining analgesic efficacy—a critical advantage given that postoperative opioid exposure often initiates long-term dependence patterns. The drug's unique pharmacology, including high receptor binding affinity and slow dissociation kinetics, likely explains its sustained analgesic duration observed across studies. However, the analysis shows substantial heterogeneity between trials, and most studies used short follow-up periods. The practical barrier remains buprenorphine's limited availability in many hospital formularies and clinician unfamiliarity with dosing protocols. For healthcare systems prioritizing both pain control and opioid stewardship, these results suggest buprenorphine deserves serious consideration as a first-line postoperative analgesic rather than a specialized alternative.