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Opioids continue to play a role in postoperative pain management and continue to result in predictable harm to patients including persistent use and overdose. 1 Buprenorphine, a partial agonist opioid, has an almost 60-year track record of efficacy in acute pain management. However, in contemporary practice, it is rarely used for this purpose and is better known as an essential medicine for opioid use disorder. In this systematic review and meta-analysis of randomized controlled trials, the authors aimed to broaden the understanding of buprenorphine’s efficacy versus opioids as a class in the treatment of acute postoperative pain in adults. Inclusion criteria were met for 58 studies.