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Management of Acute Postoperative Pain in Hand Surgery
Brian Patrick Kelley, MD; Melissa J. Shauver, MD; Kevin Chung, MD, MS
University of Michigan, Ann Arbor, MI

Introduction: Acute postoperative pain is a major concern for patients undergoing surgery. However, pain control can be difficult and a multimodal approach is often necessary. There is currently no consensus regarding the best practices for pain control after hand surgery. Furthermore, scrutiny of physician prescribing habits of analgesics is increasing in medical, federal, and public forums. We conducted a systematic review to guide hand surgeons in an evidenced-based approach in managing postoperative pain.
Materials & Methods: A literature review was performed using Medline (PubMed), EMBASE, and the Cochrane Collaboration Library for primary research articles on postoperative pain control in hand surgery patients. Inclusion criteria were primary journal articles examining treatment of acute postoperative based on any modality. Data related to pain assessment, postoperative recovery, and total postoperative analgesic consumption were extracted.
Results: A total of 903 publications were reviewed; 184 publications underwent abstract review. After applying inclusion and exclusion criteria, 10 primary articles were selected for inclusion in this review. Data were noted to be heterogeneous and findings was compiled. The results were divided into groups evaluating either postoperative pain medications or pain infusion catheters.
Conclusions: There has been little research in the area of pain control for acute postoperative pain in hand surgery patients. Though this review does not demonstrate a “best practices” model for postoperative pain management, it does provide evidence for alternative medications and treatment strategies. The evidence available suggests that postoperative pain control should begin before surgery and that combining multiple strategies for pain treatment is beneficial. Given the increasing attention paid to narcotic prescriptions and the potential for abuse, surgeons should begin to adopt evidence-based pain management practices. We provided an example algorithm for pain treatment in hand surgery based on available data and the authors' experience.

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