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Am Fam Physician. 2012;86(7):682

Background: The undertreatment of acute pain remains a problem in emergency departments. Although morphine is the analgesic of choice for the treatment of acute pain in an emergent setting, it is commonly administered intravenously, which often results in the delay of pain relief. Moreover, morphine use has serious potential adverse effects, such as respiratory depression, central nervous system depression, hypotension, and gastrointestinal problems. One possible alternative treatment is buprenorphine (Subutex), which is administered sublingually and has a high clinical safety profile and more prolonged duration of action. Jalili and colleagues investigated whether sublingual buprenorphine is as effective as intravenous morphine in managing pain in patients with acute bone fracture.

The Study: This double-blind randomized controlled trial enrolled patients 16 years or older who presented to the emergency department with acute extremity fracture. Patients were eligible for participation if they rated their pain as higher than 3 on a scale of 0 to 10, with 0 being no pain and 10 being the worst possible pain. A total of 89 patients were randomized, with 44 patients in the buprenorphine group and 45 patients in the control group. Patients in the buprenorphine group received 0.4 mg of sublingual buprenorphine and 5 mL of intravenous sterile water, whereas those in the control group received 5 mg of intravenous morphine plus a sublingual placebo. Pain was assessed using the same numeric rating scale used at baseline, and again at 30 and 60 minutes after the medications were administered. Adverse effects were recorded.

Results: Pain scores were similar between groups at 30 and 60 minutes after the medications were administered (median pain scores of 5 at 30 minutes and 2 at 60 minutes in both groups). Adverse effects were minimal in both groups and included nausea, dizziness, and hypotension.

Conclusion: In adults with acute bone fracture presenting to the emergency department, sublingual buprenorphine is as effective and safe as intravenous morphine, with quicker and easier administration.

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