Aim <p>This systematic review aims to evaluate the safety and efficacy of transdermal buprenorphine patches for pain management in post-operative orthopaedic patients compared to conventional analgesics and placebo.</p> Methods <p>A comprehensive search was conducted in Medline, Embase and Cochrane CENTRAL, covering studies up until September 2024. Studies included randomised controlled trials comparing transdermal buprenorphine with standard analgesics in post-operative orthopaedic patients. Two reviewers independently screened and extracted data, assessing outcomes related to pain relief, side effects, patient satisfaction and the need for additional analgesia. Risk of bias was assessed using the Cochrane RoB2. Cost–benefit analysis was conducted retrospectively.</p> Results <p>From 921 initial records, 579 were screened, and 13 studies met the inclusion criteria after eligibility assessment. These studies, covering various orthopaedic surgeries, evaluated transdermal buprenorphine against conventional analgesics like tramadol, fentanyl and NSAIDs. Buprenorphine consistently provided effective pain relief comparable to other opioids, with fewer respiratory and gastrointestinal side effects, particularly in elderly patients. Patient satisfaction was higher due to the steady analgesic effect and reduced need for additional analgesia. Risk of bias was rated as high in 4 studies, medium in 5 and low in 4.</p> Conclusion <p>Transdermal buprenorphine is a viable alternative for post-operative pain management in orthopaedic patients, especially the elderly. Its safety profile and consistent analgesia make it a valuable option for reducing opioid-related complications. Further research is needed to expand on these findings across diverse clinical settings.</p>