Comparative Evaluation of Efficacy of Transdermal Buprenorphine Patch versus Intraoperative Cocktail Injection for Post-operative Pain Relief in Total Hip Arthroplasty

Introduction: Effective post-operative pain control after total hip arthroplasty (THA) is essential for early mobilization, faster rehabilitation, and improved patient satisfaction. The present study was to compare the analgesic effectiveness and safety of a 5 mg transdermal buprenorphine patch versus an intraoperative periarticular cocktail injection for post-operative pain relief in THA patients, by assessing pain intensity and rescue analgesia use. Materials and Methods: This observational analytical study was carried out in the Department of Orthopedics at Gandhi Medical College and Hamidia Hospital, Bhopal, between May 2023 and April 2024. A total of 44 adult patients scheduled for THA were enrolled and divided into two equal groups. Group 1 (n = 22) received a 5 mg transdermal buprenorphine patch applied 12 h before surgery. At the same time, Group 2 (n = 22) received an intraoperative periarticular cocktail injection composed of 0.2% ropivacaine, cefuroxime, triamcinolone, ketorolac, adrenaline, and normal saline (45 mL). Post-operative pain was assessed using the visual analog scale (VAS), with scores recorded preoperatively and at 4, 8, 12, 24, 48, 72, and 120 h after surgery. The requirement and timing of rescue analgesia, as well as any adverse events, were monitored throughout the study period. Results: Baseline demographic and surgical variables were comparable between the two groups. VAS scores were similar preoperatively (P = 0.763) and at 4 h postoperatively (P = 0.853). From 8 to 72 h postoperatively, the intraoperative cocktail group reported significantly lower VAS scores (e.g., at 8 h: 5.45 ± 1.63 vs. 7.73 ± 1.42; P < 0.001) and required fewer rescue analgesic doses (mean 1.91 vs. 3.73; P = 0.008). After 120 h, pain levels converged (3.55 ± 1.26 vs. 2.95 ± 1.62; P = 0.194), suggesting more sustained pain relief in the buprenorphine patch group. Both methods were safe, with only minor and non-significant adverse events. Conclusion: Intraoperative cocktail infiltration provided superior early post-operative analgesia and reduced the need for rescue analgesia, while transdermal buprenorphine patches offered comparable and possibly more sustained pain relief by post-operative day 5. Both modalities were well tolerated. Tailoring the choice of analgesic strategy to patient-specific needs and surgical context may optimize pain management in hip arthroplasty. To the best of our knowledge, this is the first study directly comparing transdermal buprenorphine patches with periarticular cocktail infiltration for post-operative pain management in THA.