Complete Abolition of Opioid Prescribing in an Upper Extremity Surgical Practice

Abstract

Background Prescription opioids threaten potential addiction, diversion, and death. Nonopioid regimens have demonstrated similar efficacy for select upper extremity postoperative patients. Methods After adopting a practice policy completely abolishing opioid prescriptions, data were collected on all consecutive surgical cases for the next 6 months, without exclusion. There were 800 cases, 61% male and 39% female, with a mean age of 45. Seventy patients (9%) reported already using prescription medications employed in multimodality regimens; no instruction was given to alter consumption. Patients were divided into 5 groups based on the type of surgery: elective soft tissue (24%), trauma wound management (19%), soft tissue structural repairs (9%), hand fracture/bone procedures (34%), and wrist to elbow fracture/bone procedures (14%). Each group was compared directly to each other group with a 2-tailed t-test, P < .05. Results Patients reported achieving pain control without the need for further medication assistance by a mean of postoperative day 2.7. Times to pain control by group were as follows: 1.5, 3.1, 2.7, 2.9, and 3.6 days respectively. Mean postoperative daily pain scores (using a 10-point visual analog scale) for days 1 to 5 were as follows: 2.8, 2.1, 1.5, 1.0, and 0.6, respectively, with a sum of 8.0. During the 6-month tracking period, the practice only received 4 calls from patients with questions about pain control (0.5% of cases). Conclusions Patients achieved good immediate pain control without opioids and reported rapidly declining pain levels over the next several days to the point of no longer requiring medication. Type of Study/Level of Evidence Prospective cohort case series, therapeutic; Level IV.

Larger Perioperative Opioid Prescriptions Lead to Prolonged Opioid Use After Hand and Upper Extremity Surgery: A Multicenter Analysis

“…10,11 Some have even described successfully eliminating any and all opioid prescription in their hand and upper extremity surgery practice. 33 This study has several strengths. It includes data from 14 orthopaedic surgeons from three academic institutions which each for different patient populations, which increases the generalizability of our findings.…”

“… 8 , 23 , 31 , 32 In addition, studies have shown that patients take more opioids when they are given larger prescriptions, although for some hand procedures, many patients achieve adequate pain control without the use of any opioids. 13 , 23 , 27 , 32 , 33 Gaddis et al 23 performed a prospective randomized study of patients undergoing minor hand surgery being provided 10 or 30 opioid pills postoperatively. They observed that patients who received larger prescriptions consumed markedly more pills after surgery and were markedly more likely to still be taking opioids at the 2-week follow-up visit (15% versus 4%).…”

“… 10 , 11 Some have even described successfully eliminating any and all opioid prescription in their hand and upper extremity surgery practice. 33 …”

Safety and Efficacy of Liposomal Bupivacaine Supraclavicular Nerve Blocks in Open Treatment of Distal Radius Fractures

“…Furthermore, literature 59 suggests that bony procedures are associated with increased opioid consumption quantities compared with soft tissue procedures (14 vs 9 tablets, respectively). Alternatively, some hand surgeons have completely eradicated opioids from their practice with great success 60 …”

Discussion: Comparison of Postoperative Occupational Therapy and Narcotic Use in Two Carpometacarpal Arthroplasty Approaches

“…After 6 months and 800 cases, his practice received only four calls from patients with questions about pain alleviation. 8 The consequence of prescribing-let alone overprescribing-opioids is not trivial. In a study of insurance claims of patients not regularly using opioids before an elective hand surgery procedure, 13.5 percent were still filling opioid prescriptions 90 days after their procedure.…”