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Prospective Evaluation of Opioid Consumption Following Hand Surgery Performed Wide Awake Versus With Sedation
Andrew Miller, MD; Asif Ilyas, MD
Thomas Jefferson University Hospital, Philadelphia, PA

Introduction: Postoperative pain management and opioid consumption following orthopaedic surgery and hand surgery can be influenced by a multitude of variables. To better understand the effect that the type of anesthesia has on post-operative pain management, we prospectively evaluated opioid consumption post-operatively following Trigger Finger Release (TFR) and open Carpal Tunnel Release (CTR), and hypothesized that cases performed wide awake with local anesthesia and no tourniquet (WALANT) would result in increased opioid consumption compared to cases performed under sedation (MAC).

Methods: Patient post-operative opioid consumption following all consecutive cases of CTR and TFR was prospectively collected over a 6 month period. Additional data collected included patient demographics, and procedure type. The three primary endpoints of the study were the (1) evaluation of total opioid consumption, (2) the overall utilization rate of opioids, and (3) the total number of days an opioid was used for both the WALANT and MAC groups. Student t-tests were performed to evaluate statistically significant differences.

Results: Mean opioid use for MAC cases for all procedures evaluated was approximately 3.95 opioid pills compared to 3.85 opioids pills for the WALANT cases (p=0.86). The average opioid utilization rate with MAC compared to WALANT for all procedures was 62% to 49%, respectively (p=0.009). The average number of days requiring opioid use was 1.83 days for MAC cases, compared to and 1.61 days for WALANT (p=0.03).

Conclusion: The observed prevalence of post-operative opioid consumption and the number of days that opioids were used after undergoing soft tissue hand surgeries under WALANT were found to be less compared to surgeries performed under MAC. The overall amount of consumption was comparable between the two groups, and averaged less than 4 pills. These results suggest that effective pain control postoperatively may be independent of anesthesia type and we recommend that postoperative pain regimens should not be varied to reflect the modality of anesthesia. We also suggest that for common hand surgery procedures such as CTR and TFR that only a limited number of opioid pills be prescribed for post-operative pain.

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