Comparison of the Effect of Sublingual Buprenorphine and Intravenous Fentanyl on Pain Control after Cesarean Surgery

Background and Objective: One of the major challenges in women's surgery, including cesarean section, is postoperative pain control. Postoperative pain is one of the most common problems in the postoperative period that can lead to a significant reduction in the quality of surgical operations. Other problems may be associated with postoperative pains such as nausea and vomiting, hypotension and shivering. Therefore, the present study aimed to compare the effect of sublingual buprenorphine and intravenous fentanyl pump on postoperative cesarean section pain control and its effect among patients.

Methods: The present study is a randomised, double-blind clinical trial. Patients are 18-45 years old and all candidates for cesarean section at Alavi Hospital in Ardabil in 2017 -2018. After obtaining consent from patients for inclusion in the study, 80 patients were selected using simple sampling method and divided into two groups with 40 members in each group. In the first group, 40 patients received fentanyl and placebo tablets, and the pump was used to inject intravenous fentanyl and infusion lasted for up to 24 hours. The second group (40 patients) received normal saline pump and sublingual buprenorphine which repeated 6 and 12 hours after the first dose and continued up to 24 hours. Then, VRS (Verbal Rating Scale) pain score, vomiting-nausea, quantity of sedation (from ramsay sedation scale), and the amount of analgesia need for pain control at 2, 6, 12, and 24 hours, and postoperative analgesia (time of the first need to pain killer) were evaluated. Finally, all patient information was entered into a pre-designed checklist and all data were analysed using the SPSS(statistical package for the social sciences) v20 statistical analysis program.

Results: In this study, 80 patients were evaluated in two groups. The results of VRS pain score in patients showed that, except for the 24 hours after surgery, in no other postoperative time of study, the pain score in the two groups didn't show any significant difference. In the fentanyl group, the use of analgesics was higher than the buprenorphine group. During the postoperative time (hours 2 and 6), the incidence of nausea and vomiting was significantly lower in the buprenorphine group than the fentanyl group, but during the other hours, no such difference was observed. The sedation score was also evaluated, but no significant difference was observed between the two groups. Also, the incidence of other side effects in the two groups did not differ significantly.

Conclusion: The results of this study showed that buprenorphine is an effective drug in reducing postoperative pain in patients and, due to its very low side effects, it can be used routinely in patients.