Dear Editor
We have read the article entitled [1] “Efficacy of Transdermal Buprenorphine Patch in Postoperative Pain Management in Oral and Maxillofacial Surgery” by N. M. Navaneetham, R. Sham, M.E., et al. in J. Maxillofac. Oral Surg. (2022). We want to congratulate the author for the successful study in postoperative pain management in Oral and Maxillofacial Surgery and want to contribute to the same.
The transdermal fentanyl patch was found to have statistically significantly effective in controlling severe pain during active mouth-opening exercises in the postoperative management of oral submucous fibrosis patients [2]. The study by Arshad et al. [3] showed that both buprenorphine and fentanyl were effective in controlling postsurgical pain and fentanyl was better than buprenorphine. However, there is a risk of respiratory depression that makes fentanyl relatively contraindicated [3]. A ceiling effect on respiratory suppression with buprenorphine provides an excellent drug safety profile [4]. Higher doses of buprenorphine will not affect breathing and rarely cause overdose. Buprenorphine is the drug of choice for patients with long-time opioid agonist use [4].
In cases reported by the literature [5], moderate-to-severe hepatic impairment can be a side effect when buprenorphine is combined with naloxone; hence, it is recommended to prefer buprenorphine mono-product in advanced cirrhosis patients. Further side effects noticed by study [5] on discontinuing buprenorphine in the hospital put patients at risk of pain exacerbation, return to use, and longer lengths of stay; in addition, patients face logistical difficulties starting back on buprenorphine after withdrawal. The limitations of the given study [1] include importance in oral and maxillofacial surgery only and did not include measurement of plasma levels of the drug and a long follow-up study is also required. Use of buprenorphine should be justified and checked for interactions with other ongoing medications like antiviral and antifungal agents.
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References
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