Background and Aims The duration of peripheral nerve block (PNB) is of critical importance in the pain trajectories of total joint arthroplasties (TJA). Rebound pain increases opioid consumption and worsens the patient‘s functional outcome.¹ Continuous PNBs have a failure rate of 20% to 50% and they are associated with complications such as systemic local anesthetic toxicity, local infection, nerve irritation, and an increased risk of postoperative falls.²Among the alternatives studied to improve PNB analgesia, buprenorphine, a partial μ-opioid receptor agonist and weak κ-opioid receptor antagonist, has a good efficacy and safety profile.³The objective of this narrative review is to summarize the evidence about buprenorphine as perineural adjuvant to prolong analgesia after TJA.

Methods Approval from the ethical committee was not necessary for this narrative review. Two independent reviewers searched several databases (Pubmed, Embase) for articles related to the use in TJA (hip, knee, shoulder) of buprenorphine as a perineural adjuvant in PNB with or without other adjuvant molecules. Articles included were those published through March 2022 and in English.

Results 5 randomized clinical trials (RCT) were identified (Table 1). 3 trials for TKA, 1 for TSA and 1 trial for both THA and TKA. In all these 5 RCT, buprenorphine is used perineurally with local anesthetics in nerve blocks.Perineural buprenorphine alone or in combination with other adjuvants globally improve postoperative analgesia without increasing side effects such as postoperative nausea.

Conclusions Buprenorphine is effective in improving analgesia during TJAs. However, the evidence is still weak and further trials on this topic are needed.