Transdermal buprenorphine (TBUP) may have some advantages for the management of acute postoperative pain. The aim of this systematic review and meta-analysis was to investigate the efficacy and safety of TBUP compared to other analgesics or placebo for acute postoperative pain. A systematic search was conducted using Embase, MEDLINE and CENTRAL until the 26 of December 2022. The search included randomised controlled trials comparing TBUP versus other analgesics or placebo for acute postoperative pain. A certainty assessment was conducted using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. The protocol for this review was registered on PROSPERO (CRD42022318601). In total, 15 studies involving 1,205 participants were included that compared TBUP versus fentanyl (n=2), celecoxib (n=3), placebo (n=2), tramadol (n=5), diclofenac (n=3), parecoxib (n=1) and flurbiprofen (n=1). Meta-analyses were conducted for three comparators that involved 2 studies each. There was no significant difference in pain between TBUP 10mcg/h vs fentanyl 25 mcg/h (SMD -0.03, 95% CI -0.86 to 0.81, p=0.95, I=85%). TBUP 10 mcg/h was associated with less pain compared to celecoxib 200 mg twice daily (SMD -0.32, 95% CI -0.58 to -0.05, p=0.02, I=0%) and placebo (SMD -2.29, 95% CI -4.32 to -0.27, p=0.03, I=94%). The GRADE assessment showed a very low certainty of evidence for all comparisons. There is insufficient evidence that TBUP improves pain control compared to other analgesics for acute postoperative pain. PERSPECTIVE: This systematic review and meta-analysis compared the use of transdermal buprenorphine to other analgesics for post-operative pain. The results showed that is insufficient evidence to recommend the use of transdermal buprenorphine in this setting. The findings will help clinicians select the most appropriate opioid regimens for post-operative pain.