Transdermal buprenorphine versus intravenous tramadol for pain management in acute pancreatitis: A prospective randomized controlled trial
In brief
Buprenorphine and tramadol deliver similar 36-hour pain relief in pancreatitis
In a 100-person randomized trial, 64% receiving a buprenorphine patch and 62% receiving intravenous tramadol had pain scores drop by at least 3 points at 36 hours, so buprenorphine did not beat tramadol on the main outcome. Fewer buprenorphine patients needed rescue pain medicine from Day 2, but this secondary finding needs confirmation; no patient had pain reduced to 3 or lower.
- Journal
- Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] (Q1)
- Published
- 2 November 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Satinder Pal Singla, Suprabhat Giri, Dibya Lochan Praharaj, Saroj Kanta Sahu, Kshitij Kumar, Sukrati Maheshwari, et al.
- PMID
- 42982634
- DOI
- 10.1016/j.pan.2026.10.036
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 8 November 2026): Buprenorphine reduced rescue analgesia from Day 2
Abstract
BACKGROUND: Pain is a cardinal symptom of acute pancreatitis (AP), but the optimal analgesic strategy remains uncertain. We compared transdermal buprenorphine with intravenous tramadol for pain management in AP. METHODS: In this open-label trial, 100 adults with AP and baseline Visual Analogue Scale (VAS) score ≥7 were randomized 1:1 to transdermal buprenorphine (10 μg/h) (with bridging intravenous tramadol at 0 and 8 h) or intravenous tramadol (100 mg every 8 h). The primary outcome was adequate pain relief (≥3-point VAS reduction) at 36 h. Secondary outcomes were the need for rescue analgesia and adverse events. RESULTS: Adequate pain relief at 36 h occurred in 64.0% with buprenorphine and 62.0% with tramadol (RR 1.03, 95% CI 0.76-1.39; p = 0.836). VAS scores at 36 h were lower with buprenorphine (median 6 [IQR 5-6] vs 6 [IQR 6-7]; p = 0.005), though no patient had reached VAS ≤3. Day-1 rescue analgesia was similar (78.0% vs 80.0%; p = 0.800), but fewer buprenorphine-treated patients needed rescue analgesia on Day 2 (14.0% vs 34.0%; RR 0.41, 95% CI 0.19-0.91; p = 0.020; NNT 5) and Days 2-3 (14.0% vs 36.0%; RR 0.39, 95% CI 0.18-0.85; p = 0.011). Paralytic ileus (6.0% vs 6.0%) and respiratory distress (6.0% vs 4.0%) were comparable. CONCLUSIONS: This trial did not meet its primary endpoint: buprenorphine was not superior to tramadol for adequate pain relief at 36 h. Buprenorphine was associated with reduced rescue analgesia from Day 2 without increased adverse events, a hypothesis-generating finding that requires confirmation in adequately powered multicentre trials. (CTRI/2024/08/072154).
Abstract as published, via PubMed.
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