Are Opioids Needed After Hand Surgery? : A Prospective Randomized Controlled Double-Blinded Trial Comparing Acetaminophen, Ibuprofen, and Oxycodone
Asif Ilyas, MD1; Andrew Miller, MD1; Jack G Graham, BS2; Jonas Matzon, MD3;
1Orthopaedics, Rothman Institute at Thomas Jefferson University, Philadelphia, PA, 2The Rothman Institute, Philadelphia, PA, 3Rothman Institute at Thomas Jefferson University, Philadelphia, PA
Adequate postoperative pain control in hand surgery is a multifactorial issue affecting patient satisfaction, outcomes, and safety. However, prescription opioid abuse is becoming an increasingly prevalent problem in the Unites States, broadly referred to as the "Opioid Epidemic". The purpose of this study was to evaluate the efficacy of three common oral analgesics: oxycodone (OXY), ibuprofen (IBU), and acetaminophen (ACE), in the management of postoperative pain following carpal tunnel release (CTR) and trigger finger release (TFR).
Patients scheduled for primary unilateral CTR or TFR under local anesthesia alone were randomized to receive ten de-identified opaque capsules of either OXY 5mg, IBU 600mg, or ACE 500mg postoperatively. Both the patient and the surgeon were blinded to the distributed medication. Post-operatively, patients reported their worst daily pain experience (0-10 scale), the number of pills consumed daily, and any adverse effects.
Analgesic pill-type distribution between the 181 patients who completed the study was 60 OXY, 62 IBU, and 59 ACE. By procedure type, 68 underwent TFR, 62 underwent endoscopic CTR and 51 underwent open CTR. Mean total pills consumed from day of surgery through postoperative day 5 for OXY, IBU, and ACE were 3.2, 4.0, and 3.2, respectively (p > 0.05). The average worst daily pain scores for all days for the OXY, IBU and ACE groups were 2.9, 2.5 and 2.5, respectively (p < 0.05). Eleven patients experienced an adverse reaction from their medication with 9 of the 11 in the OXY group.
This study identified no clinically significant difference in pain experience or pill consumption whether patients received an opioid or non-opioid after CTR or TFR surgery. Adverse events were highest in the OXY group. Therefore, we recommend using non-opioids such as ACE and IBU after CTR and TFR surgery, and irrespective of the medication prescribed, we advise prescribing no more than 5-10 pills post-operatively. The use of non-opioids can aide in combatting opioid abuse and the "Opioid Epidemic".
The hypothesis was upheld. The study identified no difference in pain experience, pill consumption, or phone calls whether they received an opioid or non-opioid after CTR and TFR surgery. Adverse events were highest in the OXY group. The study findings imply that there is a role and validity to using non-opioids instead of opioids after common Hand Surgeries like CTR and TFR surgeries. The use of non-opioids can aide in combatting opioid abuse and the "Opioid Epidemic" at large.
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