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Narcotic Prescription Patterns Following Elective Carpal Tunnel Release
Robert G. Neumann, MD; William Mathewson, MD; Loree K. Kalliainen, MD;
Regions Hospital

Introduction

Until recently, the use of narcotic pain medication after hand surgery has received little attention and even less has been done to explore variations in prescriptions patterns by individual physicians after outpatient hand procedures. Studies by general surgeons have shown the efficacy of nonsteroidal anti-inflammatory agents (NSAIDS), but these findings have not been adopted by hand surgeons and narcotics continue to be utilized as first-line treatment. Anecdotally, prescription practices of narcotics vary widely, even when considering similar procedures between surgeons. Narcotics are not benign and are characterized by varied and well-known side effects and abuse potentials. It is desirable to determine what constitutes a reasonable post-operative prescription size. The goals of this study were 1) to describe the average number of narcotic tablets prescribed after carpal tunnel release (CTR) and to describe the variability between practitioners, 2) to identify potential patient factors related to excessive use of narcotics, and 3) to gather information to generate "Best Practice" guidelines.

Materials and Methods

A retrospective chart review of 30 consecutive CTRs for each of five hand surgeons in a single practice was performed. Patients were excluded if they had a history of chronic pain or narcotic use, if they had recurrent CTS, if there was a history of severe extremity trauma, if the procedure was done as part of a Worker’s Compensation claim, or if there were postoperative complications. The perioperative pain control (type of block) and number and type of oral narcotic pain medications were recorded. The number of tablets prescribed as refills was gathered from the electronic medical record.

Results

Between the five surgeons, there was considerable variability among the initial number of narcotic tablets prescribed with averages of 13.8, 7.0, 9.0, 20.0, and 7.2 tablets (standard deviations 14.2, 7.9, 10.6, 21, 10.2) p=0.0009. Male patients were associated with a higher average number of narcotics. The male patients had increases of 32.3%, 42.3%, 74.4%, 0%, and 53.5%. There were two narcotic refills, both for male patients. Males represented 24% of the studied patients. The age distribution was equivalent between genders.

Conclusions

This retrospective study demonstrates substantial differences in narcotic prescription patterns between surgeons in a single practice. In our study population, male gender is a characteristic associated with greater numbers of prescribed narcotics. The inter-surgeon variability indicates the opportunity to develop and study prescription guidelines for elective carpal tunnel release.


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