Narcotic-Free, Over-the-Counter Pain Management After Wide-Awake Hand Surgery

Abstract

Introduction:Prescribing opioids for postoperative pain has increased steadily, and hand surgery has been no exception. Current hand surgery literature does not describe the efficacy of pain self-management postoperatively. The purpose of this study is to describe our experience with over-the-counter (OTC), narcotic-free, postoperative pain management.Methods:We have done a retrospective chart review at an academic tertiary-care facility. Patients who underwent soft-tissue hand surgery in an office-based procedure room between January 1, 2018, and March 1, 2019, done using wide-awake local anesthesia only with no tourniquet were included.Results:Eighty-one continuous patients met the inclusion and exclusion criteria. The procedures included carpal tunnel release, cubital tunnel release, trigger finger release, first dorsal compartment release, dorsal wrist ganglion cyst excision, hand or finger mass excision, percutaneous needle fasciotomy, flexor tendon repair, and extensor tendon repair. Two patients (2.4%) received a prescription for pain medication within 1 day and 4 within 1 week after discharge (total 5.6%). Nine patients were already on chronic narcotics, and four were on short-term narcotics before the surgery date. No other patients requested or received opioid prescriptions after surgery, and no complaints were reported.Discussion:This study indicates that patients can successfully self-manage their postoperative pain with OTC analgesics. They rarely request prescriptions for pain control after soft-tissue hand surgery. Our findings support current literature suggesting that narcotic prescriptions can be eliminated in select hand and upper extremity procedures and suggest that OTC postoperative pain management is sufficient.

Patient Satisfaction and Opioid Use With a Postoperative Opioid Protocol After Common Hand Procedures

“… 2 , 11 , 12 Several studies were conducted to assess opioid consumption for tier 1 hand procedures. 2 , 4 , 5 , 6 , 9 , 10 , 11 , 15 , 16 , 17 Despite the opioid crisis, satisfaction remains a competing priority, and at times, it may be at odds with new prescribing protocols. 18 Our findings suggest that high levels of pain control and satisfaction can be achieved by adhering to a postoperative pain protocol.…”

“…Several studies conducted recently showed that implementing a prescribing protocol markedly decreased opioid use after common hand surgery. 4 , 6 , 10 , 16 , 17 , 21 Ilyas et al 4 conducted a randomized controlled trial on opioids versus nonsteroidal anti-inflammatory drugs for pain management after CTR. High satisfaction was achieved regardless of pill type, which indicates that pain relief can be achieved without opioids after surgery.…”

Complete Abolition of Opioid Prescribing in an Upper Extremity Surgical Practice

“…23 Selection bias and small patient numbers may leave surgeons with uncertainty when applied to all patients and all conditions. 6,26 Guidelines for multimodality therapy can also prove overly complex to implement in daily practice. 9,19,20,[29][30][31][32] An important component of multimodality approaches is setting the foundation for subsequent prescribing at the time of surgery.…”

“…16-22 Nonopioid medications have demonstrated equal or greater efficacy in managing postoperative pain compared to opioids. 23-28 Guidelines instruct the use of multiple modalities employed simultaneously to control pain, with an emphasis on reducing the contribution from opioids. 29-33…”

“…[16][17][18][19][20][21][22] Nonopioid medications have demonstrated equal or greater efficacy in managing postoperative pain compared to opioids. [23][24][25][26][27][28] Guidelines instruct the use of multiple modalities employed simultaneously to control pain, with an emphasis on reducing the contribution from opioids. [29][30][31][32][33] While understanding the problem is crucial, that alone does not assist the surgeon in daily practice.…”