Team Approach: Multimodal Perioperative Pain Management in Upper-Extremity Surgery

Abstract

* Rates of opioid use and abuse continue to rise in the United States, as do opioid-related deaths. Many patients who misuse opioids receive their first exposure in the perioperative setting.* Postoperative opioid use reduction in patients who have undergone an upper-extremity procedure can be difficult secondary to the often-painful nature of orthopaedic procedures. Postoperative pain can prevent timely discharge from hospitals and is a major cause for emergency medicine visits following outpatient upper-extremity surgical procedures.* Utilization of a multidisciplinary, multimodal, home-going continuous peripheral nerve block catheter protocol may be able to comfortably allow patients to recover in an outpatient setting after an upper-extremity surgical procedure, with a diminished opioid requirement.

Multimodal Analgesia with Extended-Release Dinalbuphine Sebacate for Perioperative Pain Management in Upper Extremity Trauma Surgery: A Retrospective Comparative Study

“…This issue has been further complicated by the growing opioid epidemic in the USA and the increasing insights into its detrimental effects on society [5]. The use of MMA for acute pain management is becoming a focus in upper extremity trauma surgery, as the reduction in opioid prescription and consumption continues to be a focus in the perioperative setting [21]. Simple interventions such as patient education handouts with regard to the safe and effective use of opioids after a hand surgical procedure have shown promise in reducing opioid consumption [22].…”

“…Epidural analgesia, either continuous or patient controlled; peripheral nerve blocks, either single injection or continuous; acetaminophen; nonsteroidal anti-inflammatory drugs (NSAIDs); gabapentin and ketamine have all been used for this purpose [20]. Many studies have applied MMA in upper extremity trauma surgery and reported good outcomes [21,22], but few have included DS. To reduce opioid-related adverse effects and the risk of long-term dependence and abuse, DS may be an ideal strategy.…”

Long-Term Opioid Use Following Surgery for Symptomatic Neuroma

“…However, further prescription guidelines are needed to optimize pain management: creating parameters based on specific patient characteristics along with patient education in a multidisciplinary approach. 26 28 29 30…”

Opioid Prescribing for Proximal Row Carpectomy versus Four-Corner Arthrodesis

“…Patients undergoing PRC and 4-CA often require multimodal analgesia to address postoperative pain, which frequently includes the use of opioid medications. 14 Adequately addressing postoperative pain is important in managing patient comfort and satisfaction, as well as allowing for proper functional recovery. 14 In line with the high incidence of iatrogenic opioid addiction in the United States, orthopaedic procedures requiring postoperative opioids, such as PRC and 4-CA, have increased in the past decade, thus necessitating a need to characterize the patterns of opioid consumption relative to these procedures.…”

“…14 Adequately addressing postoperative pain is important in managing patient comfort and satisfaction, as well as allowing for proper functional recovery. 14 In line with the high incidence of iatrogenic opioid addiction in the United States, orthopaedic procedures requiring postoperative opioids, such as PRC and 4-CA, have increased in the past decade, thus necessitating a need to characterize the patterns of opioid consumption relative to these procedures. 15 Therefore, the purposes of the present study were to (1) examine and compare opioid prescribing patterns and utilization surrounding PRC and 4-CA, (2) identify risk factors that predispose patients to increased perioperative and prolonged postoperative opioid use after PRC and 4-CA, and (3) examine the association between patient demographics and procedure-specific factors for perioperative health care utilization following PRC and 4-CA.…”