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Prospective Randomized Trial Studying the Effects of Pre-Operative Opioid Counseling on Post-Operative Opioid Consumption after Outpatient Upper Extremity Orthopaedic Surgery
Asif Ilyas, MD, Orthopaedics, Rothman Institute at Thomas Jefferson University, Philadelphia, PA and Michael Reynolds, BS, Thomas Jefferson University, Philadelphia, PA

Hypothesis
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 opioid consumption and to understand typical opioid consumption patterns following common outpatient upper extremity orthopaedic surgeries. The hypothesis was that patients who received pre-operative opioid counseling would consume less post-operative opioid medication and experience greater satisfaction with pain management.


Methods
Eighty-one patients undergoing outpatient shoulder, elbow, and wrist orthopaedic surgeries were prospectively randomized to receive pre-operative opioid counseling. Data collected included patient demographics, procedure and anesthesia type, and amount and type of opioid prescribed. Surveys was administered to patients on the day of surgery and “pain diaries” were given to each patient to ascertain the number of pills taken, daily visual analog pain scores (VAS), adverse events, and attitude toward their pain experience.

Results
A total of 39 patients were randomized to receive pre-operative counseling and 42 were randomized to not being counseled. On average, 26.8 pills were prescribed to each patient. Pre-operative counseling significantly reduced the total number of pills consumed to 10.6 pills versus 15.4 pills among those who were not counseled (p < 0.01). In addition, patients were satisfied with their post-operative pain experience and with no difference in refill rates between groups.

Conclusion:
Preoperative counseling significantly reduced the number of pills consumed by patients undergoing outpatient upper extremity orthopaedic surgery. Overall patients were satisfied with their pain experience with no difference in refill rates in either group. Many more opioids were prescribed than needed.


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