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American Association for Hand Surgery
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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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A Prospective, Randomized, Double-Blinded Controlled Trial Comparing Ibuprofen and Acetaminophen vs. Hydrocodone and Acetaminophen for Soft Tissue Hand Procedures
Kent Thomas Weinheimer, MD1; Brett F. Michelotti, MD2; Alexander Payatakes, MD1; (1)Penn State Hershey, Hershey, PA, (2)Plastic Surgery, Penn State Hershey Medical Center, Hershey, PA

Introduction: There has been a steady increase in opioid analgesic prescribing in the past few decades. In the current literature, it is unclear if opioids are required for post-operative pain control in soft tissue hand surgery.  This trial compared the efficacy of opioid versus non-opioid pain regimens in elective, soft-tissue hand surgery including carpal tunnel release (CTR), trigger finger release, ganglion cyst excision, and first dorsal compartment release.

Methods: This prospective, randomized, double-blinded controlled trial included patients undergoing elective, soft tissue hand procedures. Pre-operatively, patients were randomized into two treatment groups; acetaminophen/hydrocodone 325/5mg (AH, opioid group) or acetaminophen/ibuprofen 500/400mg (AIBU, non-opioid group) and followed for two weeks post-operatively with daily pain scores and visual analog scale (VAS), medication pain relief (Likert pain score), percentage needing rescue opioid prescription at one week and days until pain free.

Results: A total of 58 patients were randomized, 28 in the AH group and 30 in the AIBU group. A log-rank test showed no significant difference with respect to time until pain free, with a median of 4 days in the AH group and 3.5 days in the AIBU group, p=0.94. There was also no significant difference in percentage of patients receiving rescue opioid meds (AH 3.7% and ABIU 10%; p=0.61). A Longitudinal data analysis also showed no significant difference with respect to VAS, p=0.33 or the Likert pain score, p=0.78.

Conclusions: A combination of acetaminophen and ibuprofen is a safe and effective post-operative pain regimen for soft tissue hand surgery procedures. This treatment regimen provides equivalent analgesia when compared to hydrocodone/acetaminophen.

Type of study/Level of Evidence:

Therapeutic Level I


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