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Transdermal Buprenorphine for Pain Management in Older Patients With Multiple Rib Fractures.

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Title: Transdermal Buprenorphine for Pain Management in Older Patients With Multiple Rib Fractures.
Authors: Neupane, Iva, Mikolasko, Brian, Adams, Charles A., Monteiro, Joao Filipe Goncalves, Mujahid, Nadia, Girouard, Linda, Arabi, Jessica, Rajan, Ashna, Bose, Audrea, Lueckel, Stephanie, McNicoll, Lynn, Gravenstein, Stefan
Source: Journal of the American Geriatrics Society. Jun2026, Vol. 74 Issue 6, p1647-1657. 11p.
Subjects: Statistical hypothesis testing, T-test (Statistics), Drug administration, Patient readmissions, Fisher exact test, Multiple regression analysis, Questionnaires, Treatment effectiveness, Retrospective studies, Discharge planning, Hospital mortality, Descriptive statistics, Mann Whitney U Test, Chi-squared test, Longitudinal method, Trauma centers, Odds ratio, Pain management, Medical records, Acquisition of data, Intensive care units, Transdermal medication, Rib fractures, Comparative studies, Nonopioid analgesics, Naloxone, Length of stay in hospitals, Data analysis software, Confidence intervals, Buprenorphine, Sensitivity & specificity (Statistics), Evaluation, Old age
Geographic Terms: Rhode Island
Abstract: Background: Older trauma patients with rib fractures experience significantly higher morbidity and mortality compared to younger individuals. As effective pain control is a foundation of management, older adults present a challenge for clinicians aiming to balance pain control with adverse event risk. Despite the growing utilization of transdermal buprenorphine for acute pain, its effectiveness specifically in older patients with rib fractures remains under explored. Methods: This retrospective cohort study at a trauma intensive care unit within a Level I trauma center, examined 779 patients aged ≥ 65 years admitted with multiple rib fractures from December 1, 2022 to November 30, 2024. Outcomes were compared between those who received transdermal buprenorphine and those who did not. Primary outcome was oral morphine equivalent consumption. Secondary outcomes included non‐opioid analgesic use, naloxone administration, hospital length of stay (LOS), intensive care unit (ICU) LOS, complications, discharge disposition, in‐hospital mortality, and 30‐day readmission rates. Results: Seven hundred and eighteen admissions met inclusion criteria, with 16.4% (118) receiving transdermal buprenorphine. They were significantly older (82.0 ± 8.2 vs. 79.5 ± 8.9 years, p = 0.0054) and presented with higher comorbidities (CCI 7.3 ± 4.1 vs. 6.3 ± 3.7; p = 0.0064). Total hospital opioid use did not differ significantly. However, second day post administration opioid requirements were significantly lower in the transdermal buprenorphine group (6.5 ± 17.6 mg vs. 14.8 ± 24.9 mg, adjusted p = 0.0359), as well as overall opioid consumption after patch application (18.1 ± 46.5 mg vs. 73.8 ± 138.5 mg; adjusted p < 0.0001). No differences were observed on days three or four. We report no naloxone use in the transdermal buprenorphine group versus 1.1% in the non‐transdermal buprenorphine group. There were no significant differences in other secondary outcomes. Conclusion: Older trauma patients with multiple rib fractures treated with transdermal buprenorphine used less opioids and less naloxone during acute pain management without other benefits including LOS and mortality, suggesting a favorable safety and analgesic profile. However, a formal evaluation through a randomized controlled trial is warranted. Summary: Key points ○Multiple rib fractures in older adults are often difficult to manage, as effective pain control and respiratory rehabilitation are the mainstay of care.○This population is at a higher risk of morbidity and mortality compared to younger patients.○This study analyzes the use of transdermal buprenorphine in this specific population to suggest a favorable, safe analgesic that may help reduce overall opioid and naloxone use after administration.Why Does This Paper Matter? ○This is an important contribution to the advancement of pain management specifically in older adults with multiple rib fractures, which will hopefully inspire further research on the subject. To reduce morbidity and mortality in this vulnerable group, we must continue to find ways to balance pain control with the risk of adverse events including delirium, sedation, and respiratory depression. [ABSTRACT FROM AUTHOR]
Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Background: Older trauma patients with rib fractures experience significantly higher morbidity and mortality compared to younger individuals. As effective pain control is a foundation of management, older adults present a challenge for clinicians aiming to balance pain control with adverse event risk. Despite the growing utilization of transdermal buprenorphine for acute pain, its effectiveness specifically in older patients with rib fractures remains under explored. Methods: This retrospective cohort study at a trauma intensive care unit within a Level I trauma center, examined 779 patients aged ≥ 65 years admitted with multiple rib fractures from December 1, 2022 to November 30, 2024. Outcomes were compared between those who received transdermal buprenorphine and those who did not. Primary outcome was oral morphine equivalent consumption. Secondary outcomes included non‐opioid analgesic use, naloxone administration, hospital length of stay (LOS), intensive care unit (ICU) LOS, complications, discharge disposition, in‐hospital mortality, and 30‐day readmission rates. Results: Seven hundred and eighteen admissions met inclusion criteria, with 16.4% (118) receiving transdermal buprenorphine. They were significantly older (82.0 &#177; 8.2 vs. 79.5 &#177; 8.9 years, p = 0.0054) and presented with higher comorbidities (CCI 7.3 &#177; 4.1 vs. 6.3 &#177; 3.7; p = 0.0064). Total hospital opioid use did not differ significantly. However, second day post administration opioid requirements were significantly lower in the transdermal buprenorphine group (6.5 &#177; 17.6 mg vs. 14.8 &#177; 24.9 mg, adjusted p = 0.0359), as well as overall opioid consumption after patch application (18.1 &#177; 46.5 mg vs. 73.8 &#177; 138.5 mg; adjusted p &lt; 0.0001). No differences were observed on days three or four. We report no naloxone use in the transdermal buprenorphine group versus 1.1% in the non‐transdermal buprenorphine group. There were no significant differences in other secondary outcomes. Conclusion: Older trauma patients with multiple rib fractures treated with transdermal buprenorphine used less opioids and less naloxone during acute pain management without other benefits including LOS and mortality, suggesting a favorable safety and analgesic profile. However, a formal evaluation through a randomized controlled trial is warranted. Summary: Key points ○Multiple rib fractures in older adults are often difficult to manage, as effective pain control and respiratory rehabilitation are the mainstay of care.○This population is at a higher risk of morbidity and mortality compared to younger patients.○This study analyzes the use of transdermal buprenorphine in this specific population to suggest a favorable, safe analgesic that may help reduce overall opioid and naloxone use after administration.Why Does This Paper Matter? ○This is an important contribution to the advancement of pain management specifically in older adults with multiple rib fractures, which will hopefully inspire further research on the subject. To reduce morbidity and mortality in this vulnerable group, we must continue to find ways to balance pain control with the risk of adverse events including delirium, sedation, and respiratory depression. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.1111/jgs.70444
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      – Code: eng
        Text: English
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      Pagination:
        PageCount: 11
        StartPage: 1647
    Subjects:
      – SubjectFull: Statistical hypothesis testing
        Type: general
      – SubjectFull: T-test (Statistics)
        Type: general
      – SubjectFull: Drug administration
        Type: general
      – SubjectFull: Patient readmissions
        Type: general
      – SubjectFull: Fisher exact test
        Type: general
      – SubjectFull: Multiple regression analysis
        Type: general
      – SubjectFull: Questionnaires
        Type: general
      – SubjectFull: Treatment effectiveness
        Type: general
      – SubjectFull: Retrospective studies
        Type: general
      – SubjectFull: Discharge planning
        Type: general
      – SubjectFull: Hospital mortality
        Type: general
      – SubjectFull: Descriptive statistics
        Type: general
      – SubjectFull: Mann Whitney U Test
        Type: general
      – SubjectFull: Chi-squared test
        Type: general
      – SubjectFull: Longitudinal method
        Type: general
      – SubjectFull: Trauma centers
        Type: general
      – SubjectFull: Odds ratio
        Type: general
      – SubjectFull: Pain management
        Type: general
      – SubjectFull: Medical records
        Type: general
      – SubjectFull: Acquisition of data
        Type: general
      – SubjectFull: Intensive care units
        Type: general
      – SubjectFull: Transdermal medication
        Type: general
      – SubjectFull: Rib fractures
        Type: general
      – SubjectFull: Comparative studies
        Type: general
      – SubjectFull: Nonopioid analgesics
        Type: general
      – SubjectFull: Naloxone
        Type: general
      – SubjectFull: Length of stay in hospitals
        Type: general
      – SubjectFull: Data analysis software
        Type: general
      – SubjectFull: Confidence intervals
        Type: general
      – SubjectFull: Buprenorphine
        Type: general
      – SubjectFull: Sensitivity & specificity (Statistics)
        Type: general
      – SubjectFull: Evaluation
        Type: general
      – SubjectFull: Old age
        Type: general
      – SubjectFull: Rhode Island
        Type: general
    Titles:
      – TitleFull: Transdermal Buprenorphine for Pain Management in Older Patients With Multiple Rib Fractures.
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              M: 06
              Text: Jun2026
              Type: published
              Y: 2026
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