American Society for Peripheral Nerve

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Are Opioids Necessary to Manage Post-Operative Pain after Carpal Tunnel Release? A Prospective Cohort Evaluation
Andrew Miller, MD; Asif Ilyas, MD; Jonas Matzon, MD
Thomas Jefferson University Hospital, Philadelphia, PA

Introduction: Managing postoperative pain in hand surgery is important for both patients and surgeons. However, there is growing concern over prescription opioid abuse. We hypothesized (1) that pain medications after carpal tunnel release (CTR) surgery are over-prescribed and (2) that opioids are unnecessary in the majority of patients.

Methods: We prospectively studied two demographically similar patient cohorts receiving either opioid or tramadol for CTR performed by two hand surgery fellowship-trained orthopaedic surgeons over a 1 year period. The first cohort of patients undergoing CTR received opioids pills postoperatively. The second cohort of patients received a standard prescription of 10 tramadol pills postoperatively. Student t-tests were performed to evaluate statistically significant differences between the tramadol and opioid cohorts in total pill consumption and number of postoperative days the medication was used.

Results: The opioid cohort consisted of 159 patients with a mean opioid consumption of 4.9 pills for 2.3 days. Eleven of these patients declined the use of opioids postoperatively and instead substituted for NSAIDs and/or acetaminophen. The tramadol cohort consisted of 110 patients with a mean tramadol consumption of 3.3 pills for 1.8 days. Seven of these patients requested opioids postoperatively, and 14 substituted for NSAIDs and/or acetaminophen. When comparing the postoperative consumption of opioids and tramadol for CTR, there was a statistically significant difference in total pill consumption based on both intention to treat as well as the medication ultimately prescribed. There was no difference in the duration of postoperative utilization.

Conclusion: Following CTR, pain medications are being over-prescribed, with patients receiving more than double the amount of pills than they consume. Tramadol appears to be equally effective in managing post-operative pain compared to opioids. Based on our findings, we recommend prescribing less than 10 pills of either tramadol or an opioid to manage post-operative pain after primary CTR.

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