Transdermal Buprenorphine for Pain Management in Older Patients With Multiple Rib Fractures

BACKGROUND: Older trauma patients with rib fractures experience significantly higher morbidity and mortality compared to younger individuals. As effective pain control is a foundation of management, older adults present a challenge for clinicians aiming to balance pain control with adverse event risk. Despite the growing utilization of transdermal buprenorphine for acute pain, its effectiveness specifically in older patients with rib fractures remains under explored. METHODS: This retrospective cohort study at a trauma intensive care unit within a Level I trauma center, examined 779 patients aged ≥ 65 years admitted with multiple rib fractures from December 1, 2022 to November 30, 2024. Outcomes were compared between those who received transdermal buprenorphine and those who did not. Primary outcome was oral morphine equivalent consumption. Secondary outcomes included non-opioid analgesic use, naloxone administration, hospital length of stay (LOS), intensive care unit (ICU) LOS, complications, discharge disposition, in-hospital mortality, and 30-day readmission rates. RESULTS: Seven hundred and eighteen admissions met inclusion criteria, with 16.4% (118) receiving transdermal buprenorphine. They were significantly older (82.0 ± 8.2 vs. 79.5 ± 8.9 years, p = 0.0054) and presented with higher comorbidities (CCI 7.3 ± 4.1 vs. 6.3 ± 3.7; p = 0.0064). Total hospital opioid use did not differ significantly. However, second day post administration opioid requirements were significantly lower in the transdermal buprenorphine group (6.5 ± 17.6 mg vs. 14.8 ± 24.9 mg, adjusted p = 0.0359), as well as overall opioid consumption after patch application (18.1 ± 46.5 mg vs. 73.8 ± 138.5 mg; adjusted p < 0.0001). No differences were observed on days three or four. We report no naloxone use in the transdermal buprenorphine group versus 1.1% in the non-transdermal buprenorphine group. There were no significant differences in other secondary outcomes. CONCLUSION: Older trauma patients with multiple rib fractures treated with transdermal buprenorphine used less opioids and less naloxone during acute pain management without other benefits including LOS and mortality, suggesting a favorable safety and analgesic profile. However, a formal evaluation through a randomized controlled trial is warranted.