Comparison of intravenous pethidine and sublingual buprenorphine on postoperative pain severity in patients with vertebral fracture surgery: a randomized multicenter, double-blind controlled trial

Ann Med Surg (Lond). 2025 Dec 19;88(2):1383-1390. doi: 10.1097/MS9.0000000000004551. eCollection 2026 Feb.

ABSTRACT

BACKGROUND: The present study aims to compare the efficacy of intravenous pethidine with sublingual buprenorphine in pain relief following surgical intervention for vertebral fractures.

METHOD: This study is a randomized, double-blind clinical trial conducted among individuals undergoing surgery for thoracic and lumbar vertebral fractures. Before surgery, all patients received 1 g of intravenous acetaminophen. Sublingual buprenorphine was administered at 0.4 mg in three doses before surgery and two doses after surgery. Alternatively, patients received intravenous pethidine at a dose of 25 mg in two doses before surgery and one dose after surgery. Postoperative pain was monitored for the first 24 h using the Visual Analog Scale, and any treatment-related adverse effects were also assessed.

RESULTS: In this study, the mean age of patients was 55.10 ± 13.24 years, with 55% being male. Only 16 (13.3%) of the patients evaluated experienced nausea and vomiting. The most common fracture site among the subjects was lumbar, with a frequency of 72 patients (60%). The mean pain scores increased postoperatively compared to preoperative scores and decreased over time. No statistically significant differences were observed between the two groups at any time point. According to the repeated measures analysis of variance statistical test, two groups had no significant changes in pain levels.

DISCUSSION: Sublingual buprenorphine does not differ from intravenous pethidine regarding pain intensity following vertebral fracture surgery; however, it is considered safer with fewer side effects. Furthermore, the trend of pain changes in both treatment groups did not show significant differences.

PMID:41675814 | PMC:PMC12889261 | DOI:10.1097/MS9.0000000000004551