PREMEDICATION WITH SUBLINGUAL BUPRENORPHINE FOR OUTPATIENT ARTHROSCOPY - REDUCED NEED FOR POSTOPERATIVE PETHIDINE BUT HIGHER INCIDENCE OF NAUSEA

The effect of preoperative sublingual buprenorphine (B) on postoperati ve pain (VAS), the need for postoperative opioid injections and on tim e to discharge, was evaluated in a prospective randomised double-blind study. Forty ASA I-II patients scheduled for arthroscopy of the knee received premedication with 0.4 mg buprenorphine (group B) and 42 pati ents were given placebo (group P). Postoperatively, pethidine was give n to patients with pain. Three of the 40 patients in group B vs 11 of the 42 in group P received pethidine (P<0.05). Ingroup B, however, 13 of the 40 patients complained of nausea, prolonging median time to dis charge from 155 to 255 minutes (P<0.05). In group P, 3 of the 42 patie nts were nauseated, P<0.01, compared with group B. Time to discharge d id not differ between the groups in patients without nausea. The media n respiratory rate was significantly lower in group B, but no patient required ventilatory support. In conclusion, premedication with sublin gual buprenorphine cannot be recommended for this procedure. It reduce s the need for postoperative injections of pethidine but increases the incidence of postoperative nausea which prolongs the recovery time. C areful monitoring is also mandatory because of the possibility of resp iratory depression.