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Pain Outcomes After Intra-Operative Acetaminophen and Ketorolac for Carpal Tunnel and Distal Radius Surgeries
Eva Maria Urrechaga, BS1; John Fowler, MD1; Carmella Fernandez, MD2
1University of Pittsburgh, Pittsburgh, PA, 2Yale University School of Medicine, New Haven, CT
Introduction: Multi-modal pain management with peri-operative administration of intravenous (IV) acetaminophen and/or ketorolac has become the standard of care in total joint arthroplasty, decreasing post-operative pain and opioid use and improving clinical outcomes. However, the efficacy of these medications in hand surgery is limited. If the medications do not affect peri-operative pain and opioid use, the risks of the medications, albeit rare, would not outweigh the reported benefits and the medications should not be used. The purpose of this study is to determine if peri-operative administration of IV acetaminophen and/or IV ketorolac decreases post-operative pain and opioid consumption for two common procedures, endoscopic carpal tunnel release (CTR) and distal radius open reduction internal fixation (ORIF).
Methods: This experimental, randomized, double-blind, placebo-controlled study included 4 treatment arms for each procedure (CTR and ORIF). Both groups were separately randomized into intra-operative treatment with placebo (Group 1), IV acetaminophen (Group 2), IV ketorolac (Group 3), or both IV acetaminophen and IV ketorolac (Group 4). An a priori power analysis determined that eleven subjects per treatment group were required (total of 88 patients) are required to detect a difference in visual analog scale (VAS) pain of 1.0 between groups. Patients recorded VAS pain at 8 hour intervals and daily opioid for seven days after surgery. ANOVA was used to compare mean pain and opioid consumption between groups.
Results: Patient recruitment is ongoing. Preliminary results show no significant difference in 7-day average VAS pain between treatment groups for CTR (p=0.55) or ORIF (p=0.08). VAS pain was analyzed each day of the post-operative period to determine possible differences early in the post-operative period (Day 1). No significant difference was found for either CTR (p=0.93) or ORIF (p=0.38). There was no significant difference in 7-day opioid consumption between groups for CTR (p=0.31) or ORIF (p=0.42). Day 1 opioid consumption did show a significant difference in the ORIF group (p=0.0), but not in the CTR group (p=0.29). At the time of submission, 7 patients in the ORIF group and 20 patients in the CTR group have completed surveys.
Conclusion: Preliminary data shows intra-operative administration of acetaminophen and/or ketorolac provides no difference in post-operative pain or opioid consumption in the early post-operative period for CTR and distal radius ORIF surgeries.
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