American Association for Hand Surgery
Theme: Beyond Innovation

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The Effect of Pre-Operative Counseling on Post-Operative Pain Experience after Outpatient Hand Surgery: A Prospective Randomized Trial
Talia Chapman, MD; Rothman Institute / Jefferson, Philadelphia, PA; Kristin Sandrowski, MD; Thomas Jefferson University, Philadelphia, PA; Asif Ilyas, MD
Orthopaedics, Rothman Institute at Thomas Jefferson University, Philadelphia, PA

INTRODUCTION:
Postoperative pain management and opioid consumption following outpatient hand surgery may be influenced by a number of variables including pre-operative counseling, type of procedure or anesthetic, and patient demographics. A prospective randomized study was undertaken to understand the effect of pre-operative opioid counseling on post-operative opioid consumption and pain experience after hand surgery.

METHODS:
Consecutive patients undergoing outpatient hand surgery by six hand surgery fellowship-trained surgeons were prospectively randomized to receive pre-operative opioid counseling. Data collected included patient demographics, procedure type, anesthesia type, and amount and type of opioid prescribed. An electronic survey was administered on post-operative day three to ascertain the amount of opioids consumed, daily visual analog pain scores (VAS), adverse events, and attitude toward their pain experience. Statistical tests used to perform this analysis included unpaired t-tests and Fisher's exact tests for continuous and dichotomous variables, respectively.
RESULTS:
Post-operative data was available for a total of 134 patients. Sixty-two patients were randomized to receive pre-operative counseling and 72 were randomized to not receiving any counseling. On average, 13 pills were prescribed to each patient. Average number of pills consumed (4.8 vs 4.7) and visual analog pain scores over the first three post-operative days were not significantly different between the two groups. However, older patients had significantly lower VAS pain scores (p=0.0001) and took fewer pills (p= 0.005). Patients who underwent bone procedures consumed more pills than patients who underwent soft tissue procedures which trended toward significance (6 vs 4.1; p=0.1). Patients who were not counseled (p=0.03) and chronic opioid users (p=0.007) were more likely to think that the number of pills that they were prescribed was insufficient.
CONCLUSION:
More opioids were prescribed than needed after outpatient hand surgery, on an average of 3:1. There was no significant decrease in opioid consumption with pre-operative counseling, but those who were counseled were more likely to be satisfied with their post-operative pain experience. Also, patients without counseling and those with a history of chronic opioid use were not satisfied with the number of opioids prescribed and less satisfied with their overall pain experience.


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