TOPLINE:

Older adults with multiple rib fractures who received transdermal buprenorphine used less opioid medication for pain control after patch application than those who were managed without the patch. Patients in the transdermal buprenorphine group were less likely to require high-dose opioids, and no naloxone was required.

METHODOLOGY:

• Researchers conducted a retrospective cohort study at a level I trauma center including 718 patients aged 65 years or older admitted with multiple rib fractures from December 2022 to November 2024.
• A total of 118 patients received a transdermal buprenorphine patch of 5 μg/h (mean age, 82.0 years) and 600 patients were managed without transdermal buprenorphine (mean age, 79.5 years), with all patients receiving standing orders for acetaminophen and lidocaine patches.
• The primary outcome was the total consumption of opioids (quantified as oral morphine equivalents) during hospitalization, with specific assessments performed on days 2, 3, and 4 after patch application.
• Secondary outcomes included the use of non-opioid analgesics and high-dose opioids, administration of naloxone, length of stay in the hospital and trauma ICU, complications, discharge disposition, mortality, and rates of 30-day readmission.
• Patients were monitored for side effects, such as changes in respiratory rates, alterations in mental status, and constipation.

TAKEAWAY:

• The total use of opioids during hospitalization did not differ between the two groups; however, patients who did vs did not receive transdermal buprenorphine had lower requirements for opioids on day 2 after application of the buprenorphine patch (mean, 6.5 vs 14.8 mg; adjusted P = .0359) and a lower cumulative use of opioids after patch application (mean, 18.1 vs 73.8 mg; adjusted P < .0001).
• Patients in the transdermal buprenorphine group were less likely to require high daily doses of opioids of 30 mg or more of oral morphine equivalents; none of the patients in this group, compared with eight patients (1.3%) in the nontransdermal buprenorphine group, required naloxone for opioid reversal.
• The transdermal buprenorphine group showed a lower utilization of adjunctive non-opioid analgesics, specifically lidocaine patches and ibuprofen.
• No differences were observed between the two groups in terms of the length of stay in the hospital or trauma ICU, in-hospital mortality, 30-day mortality, and rates of 30-day readmission.

IN PRACTICE:

“Transdermal buprenorphine is probably an appropriate adjunct for pain management, but further studies are needed to evaluate the use of transdermal buprenorphine in trauma patients,” the authors of the study wrote.

SOURCE:

The study was led by Iva Neupane, MD, of the Department of Medicine at The Warren Alpert Medical School of Brown University in Providence, Rhode Island. It was published online on April 16, 2026, in the Journal of the American Geriatrics Society.

LIMITATIONS:

A relatively small sample size of patients used the buprenorphine patch, which may affect the statistical power of the study. The researchers did not evaluate the impact of the patch on incentive spirometry readings, which provide an indirect measure of pulmonary rehabilitation after rib fractures. No additional buprenorphine doses were given to patients during the 24- to 48-hour period until the patch reached full therapeutic effect. Patient-reported outcomes were not captured.

DISCLOSURES:

No funding information was reported. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.