No significant difference in the pain experience for patients on opioids vs non-opioids after hand surgery

LAS VEGAS — No significant differences in the pain experience or pill consumption were seen between patients who received an opioid vs. a non-opioid after carpel tunnel or trigger finger release, according to a presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.

“Careful postoperative opioid prescribing after orthopedic surgery is an important step for orthopedic surgeons to consider doing to assist in our collective effort to stem rising opioid diversion and abuse in America,” Asif M. Ilyas, MD, told Healio.com/Orthopedics. “Cultural dogma in America today is that all surgeries require an opioid postoperatively.”

He added, “What we found was no statistical difference in usage, efficacy or refill rates, regardless of which painkiller they were given postoperatively after common hand surgeries. We now subsequently recommend prescribing non-opioids postoperatively after similar surgeries whenever possible and prescribe opioids in smaller quantities if needed.”

Ilyas and colleagues identified 111 patients for their study. Of this group, 74 patients were scheduled to undergo primary unilateral carpal tunnel release and 37 patients underwent trigger finger release under local anesthesia alone and without sedation. Patients were randomized to receive 10 de-identified opaque capsules of analgesic pills. There were 39 patients assigned to receive oxycodone 5 mg, 35 patients received ibuprofen 600 mg and 37 patients received acetaminophen 500 mg postoperatively. Patients and the surgeon were blinded to the administered analgesic pills. Investigators had patients report daily pain experience, number of pills consumed each day, adverse effects and the need for additional or different oral analgesics from 0 to 5 days postoperatively.

Investigators found the average total pills consumed from 0 to 5 days postoperatively was 2.9 pills for the oxycodone group, 4.4 pills for the ibuprofen group and 3.1 pills for the acetaminophen group. For all of the days, the average VAS score for the worst pain experienced postoperatively was 3.1 for the oxycodone group, 3 for the ibuprofen group and 2.2 for the acetaminophen group. No difference was seen between the treatment groups with regard to requests for different or stronger medications.

Patients who received oxycodone reported the greatest number adverse events; however, the adverse events were minor and required no operations or re-admissions. Results did not change after a subanalysis was performed for carpel tunnel vs. trigger finger release. – by Monica Jaramillo

Reference:

Ilyas AM, et al. Paper 109. Presented at: the American Academy of Orthopaedic Surgeons Annual Meeting; March 12-16, 2019; Las Vegas.

Disclosure: Ilyas reports no relevant financial disclosures.