Reducing Opioid Exposure Following Common Ambulatory Hand Surgery, a Systematic Review.

Mason J. Horne DPT1, Vasanth S. Kotamarti MD1, Ashit Patel M.B.Ch.B.2
1Albany Medical Center, Albany, NY
2Duke University Medical Center, Durham, NC

Introduction

The opioid epidemic is a health crisis in the United States and physicians contribute by overprescribing opioids

Ambulatory hand surgery is common in the US and associated with opioid over-prescription

There is a lack of guidance for safe and effective analgesia following ambulatory hand procedures

Current literature was assessed to suggest evidence-based protocols for postoperative analgesia and opioid reduction strategies

Methods

A systematic review was performed using PubMed, Web of Science, and Cochrane Library

Identification of studies comparing nonopioid to opioid treatments for pain management following ambulatory hand surgery

Identification of studies investigating opioid sparing strategies after ambulatory hand surgery

Evidence was examined toand provide determine efficacy of nonopioid interventions recommendations for optimal non-opioid protocols and opioid sparing strategies

Key Search Phrase

(("Opioid" OR "Pain Management” OR “non-opioid” OR “nonopioid") AND ("carpal tunnel release" OR "trigger finger release" OR "tenosynovectomy" OR "fasciectomy" OR "Hand Surgery"))

Discussion

No evidence reported superior pain relief with opioids compared to nonopioids

Multiple studies reported superior pain relief with non-opioids compared to opioids

Multiple studies reported more adverse effects with opioid use compared to nonopioids

No studies reported higher patient satisfaction with pain management with opioids compared to non-opioids

Multiple studies reported improved functional outcome scores with nonopioid use compared to opioids

Preoperative opioid education with postoperative hand out lead to reduced opioid consumption following ambulatory hand surgery

Conclusion

Nonopioid interventions are adequate in multiple aspects of pain management compared to opioids for common ambulatory hand procedures

Recommendations were established for 2 nonopioid treatment protocols, and for an opioid sparing intervention (level I and II evidence)

Evidence provided in this review should be strongly considered for pain management guidance following ambulatory hand surgery and provides a means to decrease opioid overprescribing in the US

Limitations/Future Studies

The majority of RCTs in this review excluded patients who were chronically using opioids or that used opioids within a period before surgery

Future RCTs should include patients who use opioids for chronic pain management