Acute Postoperative Swelling After Hand Surgery: An Exploratory, Double-Blind, Randomised Study With Paracetamol, Naproxen, and Placebo

Abstract

A model using volumetry to evaluate the effect of drugs on acute postoperative swelling after operations for primary Dupuytren's contracture (DC) and carpal tunnel syndrome (CTS) was established and validated. The temperature of the saline and time of measurement during the day influenced the volumetric readings. The error of measurement after volumetry of unoperated and operated hands after operations for DC was 0.7% and 0.6%, respectively. Naproxen (500 mg twice a day), paracetamol (1000 mg four times a day), or placebo were given postoperatively for three days to 35 patients after DC and 42 patients after CTS in a randomised, placebo-controlled study. Hand volume was measured preoperatively and 72 hours after surgery. There was a difference in swelling (p = 0.009) indicating different degree of development of swelling 72 hours postoperatively between the DC and CTS placebo groups, which invalidated pooling of the data. After operations for DC naproxen was slightly but not significantly superior to paracetamol and placebo, with paracetamol numerically superior to placebo. The power of the study, caused by the limited number of patients included, does not permit this difference to reach significance. Operations for CTS caused so little swelling that comparisons were invalidated. Naproxen treatment, irrespective of type of operation, did not require rescue analgesics, while two patients after CTS treated with paracetamol did. Two and six placebo-treated patients required rescue drugs after operations for DC and CTS, respectively. We conclude that naproxen might have a clinical relevant effect on swelling when used on minor surgery in the hand, unlike paracetamol. Naproxen might be a useful analgesic during the immediate postoperative phase.

Comparison of the efficacy of low doses of methylprednisolone, acetaminophen, and dexketoprofen trometamol on the swelling developed after the removal of impacted third molar

“…In another study of the same authors, 1000 mg acetaminophen was demonstrated to have preferable anti-inflammatory effects in comparison to 600 mg ibuprofen ( 11 ). Nonetheless, there are studies reporting that acetaminophen used at high doses had no preventable effect on swelling ( 27 ). According to the results of our study, 300 mg acetaminophen exhibited approximate clinical results with 12.5 mg DT, a NSAID.…”

A 15-Year Review of Clinical Practice Patterns in Carpal Tunnel Syndrome Based on Continuous Certification by the American Board of Plastic Surgery

“…Information regarding multimodal pain management strategies would prove helpful to hand surgeons as well. [63][64][65][66] Lastly, protocols for dressing following carpal tunnel surgery should be better studied. Removal of the bulky dressing before 72 hours has not been shown to cause wound complications.…”