For years, investigators have studied the efficacy of various opioids added to a local anesthetic near the brachial plexus as a method for providing postoperative analgesia in the ambulatory surgical patient. It appears from several of these studies that buprenorphine provides the longest duration of analgesia, which is the most important parameter of postoperative analgesia in outpatients. A study by Modi, Rastogi, and Kumar evaluated the efficacy of buprenorphine in providing prolonged postoperative analgesia when added to 0.5% bupivacaine with epinephrine 1:200,000. The study involved 50 healthy adult patients who were scheduled for surgery. The patients were randomly assigned to 2 groups: group 1 received 40 mL of a local anesthetic alone, and group 2 received the same local anesthetic plus buprenorphine 0.3 mg. The study was double-blind, with one dentist preparing the solutions, a second dentist performing the intraoral nerve blocks, and a third dentist monitoring the anesthesia and analgesia thereafter, up to and including the time of the first request for an analgesic medication. The study found that the addition of buprenorphine to the local anesthetic used for intraoral nerve blocks provided a 3-fold increase in the duration of postoperative anesthesia, with complete analgesia persisting 30 hours beyond the duration provided by the local anesthetic along in 75% of patients. The authors conclude that in view of the absence of adverse side effects in this small group of patients, the addition of buprenorphine to bupivacaine for intraoral nerve blocks in patients undergoing same-day surgery may be a way to provide postoperative analgesia for outpatients.
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