Analgesic Drug Prescription After Carpal Tunnel Surgery

Fuzier, Régis; Serres, Isabelle; Bourrel, Robert; Palmaro, Aurore; Lapeyre‐Mestre, Maryse

doi:10.1097/aap.0000000000000685

Cited by 6 publications

(11 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Such opioid abuse is increasing rapidly, and the US sees this as an opioid-epidemic crisis. Abuse of opioids can be reduced by reducing initial prescriptions 15. As shown in this study, carpal tunnel surgery through WALANT resulted in significantly lower use of opioids than other anesthesia methods, due to less postoperative pain.…”

Section: Discussionmentioning

confidence: 59%

See 1 more Smart Citation

<p>Open cubital and carpal tunnel release using wide-awake technique: reduction of postoperative pain</p>

Kang¹,

Park²,

Park³

et al. 2019

JPR

View full text Add to dashboard Cite

PurposeThis study aimed to compare the efficacy of and patient satisfaction with the wide-awake local anesthesia with no tourniquet (WALANT) technique in open cubital and carpal tunnel release surgery.MethodsFrom January 2016 to February 2017, 20 cubital tunnel syndrome (CuTS) patients were in a wide-awake (WA) group and 22 in a general (GA) anesthesia group in . Also, 20 carpal tunnel syndrome (CTS) patients were in a WA group, 22 in a local anesthesia (LA) group, and 20 in a GA group. Injection pain, perioperative pain, and postoperative pain were assessed using a 10-point pain VAS. In CuTS, functional outcome on the “quick” Disabilities of the Arm, Shoulder, and Hand questionnaire were evaluated. In CTS, subjective outcomes were assessed using the Korean version of the Michigan Hand Outcomes Questionnaire.ResultsBoth CuTS and CTS showed significant postoperative pain reduction in group WA. In CuTS, group WA had less pain than group GA up to 48 hours after surgery (P<0.05). Supplemental opioid injections were used on hospitalization day by 12% of group WA and 35% of group GA. In CTS, the postoperative VAS scores in group WA were lower during the first 24 hours than groups LA and GA (P<0.05). Opioid injections were used on hospitalization day by 5% of WA, 18% of LA, and 32% of group GA. There was no difference in postoperative functional outcomes according to anesthesia method in CuTS or CTS.ConclusionCubital and carpal tunnel surgery using the WALANT technique was comparable in function to other anesthesia methods and superior for pain. Immediate postoperative pain was much lower than other groups, which could reduce the use of opioids during hospitalization.

show abstract

Section: Discussionmentioning

confidence: 59%

“…Intravenous opioid (tramadol) injections were used on hospitalization day by 15% of WA and 36% of GA in CuTS and by 5% of WA, 18% of LA, and 30% of GA in CTS. Fuzier et al reported that the rate of opioid use after carpal tunnel surgery was 39% 15. Recently, the use of opioids has caused serious social problems.…”

Section: Discussionmentioning

confidence: 99%

<p>Open cubital and carpal tunnel release using wide-awake technique: reduction of postoperative pain</p>

Kang¹,

Park²,

Park³

et al. 2019

JPR

View full text Add to dashboard Cite

show abstract

“…The search of electronic databases yielded 7534 citations. After removal of duplicates and full-text reviews, a total of 33 studies involving 1 922 743 individuals, with 1 854 006 (96.4%) from the US . The PRISMA diagram is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Information on age was available in 22 studies 11,12,27,29,30,33,48,50,53,54,[58][59][60][62][63][64][65][66][67][68][69] ; the mean (SD) age JAMA Network Open | Surgery of participants was 59.3 (12.8) years. The minimum age of participants was 39.0 years and the maximum age was 80.0 years.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Eight studies (24.2%) enrolled only opioid-naive participants, 11,12,16,30-32,46,50 18 (54.5%) enrolled both opioid-naive and opioid-experienced participants, 27,29,33,48,49,51,52,[55][56][57][58][59][60][61]66,70 and the remaining 7 studies lacked sufficient information to categorize participants. 47,53,54,[62][63][64][65] The definitions of long-term, persistent, and prolonged opioid use and opioid naivety varied across studies (Table 1, and eTables 1-2 in the Supplement). Subgroup analysis based on quality was not performed because the individual summed score from the Newcastle-Ottawa-Scale varied between 7 and 9, suggesting that all included studies were high quality.…”

Section: Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Rate and Risk Factors Associated With Prolonged Opioid Use After Surgery

et al. 2020

View full text Add to dashboard Cite

IMPORTANCE Prolonged opioid use after surgery may be associated with opioid dependency and increased health care use. However, published studies have reported varying estimates of the magnitude of prolonged opioid use and risk factors associated with the transition of patients to longterm opioid use. OBJECTIVES To evaluate the rate and characteristics of patient-level risk factors associated with increased risk of prolonged use of opioids after surgery. DATA SOURCES For this systematic review and meta-analysis, a search of MEDLINE, Embase, and Google Scholar from inception to August 30, 2017, was performed, with an updated search performed on June 30, 2019. Key words may include opioid analgesics, general surgery, surgical procedures, persistent opioid use, and postoperative pain.STUDY SELECTION Of 7534 articles reviewed, 33 studies were included. Studies were included if they involved participants 18 years or older, evaluated opioid use 3 or more months after surgery, and reported the rate and adjusted risk factors associated with prolonged opioid use after surgery. DATA EXTRACTION AND SYNTHESISThe Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed. Two reviewers independently assessed and extracted the relevant data. MAIN OUTCOMES AND MEASURESThe weighted pooled rate and odds ratios (ORs) of risk factors were calculated using the random-effects model. RESULTSThe 33 studies included 1 922 743 individuals, with 1 854 006 (96.4%) from the US. In studies with available sex and age information, participants were mostly female (1 031 399; 82.7%) and had a mean (SD) age of 59.3 (12.8) years. The pooled rate of prolonged opioid use after surgery was 6.7% (95% CI, 4.5%-9.8%) but decreased to 1.2% (95% CI, 0.4%-3.9%) in restricted analyses involving only opioid-naive participants at baseline. The risk factors with the strongest associations with prolonged opioid use included preoperative use of opioids (OR, 5.32; 95% CI, 2.94-9.64) or illicit cocaine (OR, 4.34; 95% CI,) and a preoperative diagnosis of back pain (OR, 2.05; 95% CI, 1.63-2.58). No significant differences were observed with various study-level factors, including a comparison of major vs minor surgical procedures (pooled rate: 7.0%; 95% CI, 4.9%-9.9% vs 11.1%; 95% CI, 6.0%-19.4%; P = .20). Across all of our analyses, there was substantial variability because of heterogeneity instead of sampling error. (continued) Key Points Question What are the rate and risk factors associated with prolonged use of opioid medications after surgery? Findings In this systematic review and meta-analysis of 33 observational studies including more than 1.9 million patients, 7% of patients continued to fill opioid prescriptions more than 3 months after surgery. Preoperative use of opioids, illicit cocaine use, and pain conditions before surgery had the strongest associations with prolonged opioid use after surgery. Meaning The findings suggest that an eval...

show abstract