Perioperative Buprenorphine Management and Postoperative Pain Outcomes: A Retrospective Study with Evidence-Based Recommendations

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

File attached with suggestions

Comments for author File: Comments.pdf

Comments on the Quality of English Language

 

I believe that some sentences (noted in the suggestions) should be rephrased for clarity

Author Response

13: After “versus” I think it would be better to write “patients who discontinued” for more precision
reponse: this was corrected

20-21: I suggest to rephrase the last sentence for more clarity, specially the expression “and having a decrease in relapse” which doesn´t seem to fit properly with the rest of the sentence.
response: the phrase was re-worded

38-49: I recommend to include the references to the data exposed
response: reference was added

49-61: There is only this reference, that has already been used. I suggest that more references were used to backup some of the affirmations in the paragraph
response: more references were added

61-71: I think that references should be added, there are many sentences that can be seen as an author opinion. Except from the hypothesis and study presentation (from line 73), the lack of references for the reader to understand the background is a key point, from my point of view.
response: see above, more references were added

85-86: Differences in dosing should be explained or referenced as it is an exclusion criteria
response: differences were addressed

93-95: Concerning post operative pain, I recommend that the fact that those different kind of surgeries are included should be explained, as one can think that pain outcomes are different after each of them.
response: differences were addressed

137-140: I believe that this sentence does not belong to the discussion, and more to the introduction, as it shows why the author decided to do the study. Also, in case you want to maintain the sentence, I would suggest to change “spark” for a less colloquial term
response: sentence was removed

159-163: I suggest that the explanation to why the results lead to that conclusion should be explained in depth
response: explanation provided

166-167: I recommend to add data concerning that risk
response: references added

170-174: I don´t think that this recommendation fits the discussion part. Maybe at the end of the conclusion? If there´s a reference it might me included but the recommendation seems to be out of the paper objective, concerning its introduction and methods
response: moved to conclusions

181-183: This first sentence should be taken out from the conclusion, unless it is included in the reference for the other one
response: sentence removed

181-196: I believe that there´s too much of reference number 3 in this part. Also, the paper is used to support the author´s perspective and, for the discussion part, it should be put in contrast, but only the points that are (or not) in common with the present study. In any case the reference is used during the whole paper
response: additional references added

197-199: This sentence should be rephrased for clarity
response: sentence rephrased

201-213: I believe that some of the affirmations of what´s need for future research, the author should base on data and sample size from this very paper. The way it´s written it looks more as a personal opinion. I think that it should be expressed more accurately, concerning the discussion
response: future goals framed in reference to our study limitations

213-235: I think that these limitations justify that some of the affirmations concerning what this paper brings to the field should be done more cautiously
response: rephrased and some portions removed

236: I don´t think that, with this data and sample size, “there is a clearly a benefit” should be stated
response: phrase was removed

241-244: In the same line as said before, I think that conclusions should be more cautious concerning the paper´s consistency
response: limitations addressed

Reviewer 2 Report

Comments and Suggestions for Authors

The authors report postoperative pain intensities and opioid dosages in 35 CP and OUD patients who continued of discontinued buprenorphine for surgery.

Lines 13-17: please present data on buprenorphine continuation vs discontinuation in the same order throughout the abstract and the paper.

Line 85: It is not clear why authors excluded buprenorphine patch which is tipically used for CP. Intersubject differences always do exist not only as far as dosages but also in terms of pharmacokinetics. Please report the type of buprenorphine patients had been taking prior surgery (ie, buccal, sublingual etc).

Please report in Methods and Table 2 what you used to assess pain intensity (ie, VAS or NRS).

Table 2 and 3. It would be interest to know pain intensities and analgesic dosages in patients who either continued or discontinued buprenorphine that had been taken for CP or OUD (ie, usually higher).

Several recent papers on the issue of buprenorphine discontinuation during hospitalization and surgery are not cited (Patel et al 2024; Mosher et al 2024 Hauck et al 2023; Hathaway et al 2023; Stone et al., 2022).

Author Response

Lines 13-17: please present data on buprenorphine continuation vs discontinuation in the same order throughout the abstract and the paper.
response: order changed to be consistent throughout

Line 85: It is not clear why authors excluded buprenorphine patch which is tipically used for CP. Intersubject differences always do exist not only as far as dosages but also in terms of pharmacokinetics. Please report the type of buprenorphine patients had been taking prior surgery (ie, buccal, sublingual etc).
response: differences addressed

Please report in Methods and Table 2 what you used to assess pain intensity (ie, VAS or NRS).
response: VAS included

Table 2 and 3. It would be interest to know pain intensities and analgesic dosages in patients who either continued or discontinued buprenorphine that had been taken for CP or OUD (ie, usually higher).
response: mean pain scores listed in Table 2 and mean dose listed in result section 3.1

Several recent papers on the issue of buprenorphine discontinuation during hospitalization and surgery are not cited (Patel et al 2024; Mosher et al 2024 Hauck et al 2023; Hathaway et al 2023; Stone et al., 2022).
responses: papers have now been added to the discussion section

Reviewer 3 Report

Comments and Suggestions for Authors

I would like to express my gratitude for the opportunity to review the manuscript titled "Perioperative Buprenorphine Management and Post-operative Pain Outcomes."

 

Despite the important limitations well described by the authors in the discussion section, the manuscript is very well written and provides important insights into postoperative pain management.

 

I have only a minor suggestion to improve the manuscript. While the topic is highly relevant and the retrospective design offers practical insights, the comparison with other analgesic protocols, including regional anesthetics, or multimodal analgesia, for example, is missing and should be expanded in the discussion section. This will also help to increase the bibliography that supports the study.

Author Response

I have only a minor suggestion to improve the manuscript. While the topic is highly relevant and the retrospective design offers practical insights, the comparison with other analgesic protocols, including regional anesthetics, or multimodal analgesia, for example, is missing and should be expanded in the discussion section. This will also help to increase the bibliography that supports the study.
response: this information was added to the discussion section

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

In the Table, please spell out abbreviations in the footnotes.