Implementation of a Postoperative Opioid Prescribing Protocol Significantly Reduces Total Morphine Milligram Equivalents Prescribed

Earp, Brandon E.; Silver, Jacob; Mora, Ariana N.; Blazar, Philip

doi:10.1016/j.jhsa.2018.06.035

Cited by 2 publications

(2 citation statements)

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“…Following the institution of these interventions, there was a 52.3% reduction in mean morphine prescription by orthopedic surgeons. Earp et al 34 assessed the use of an opioid prescription protocol following common upper-extremity procedures and found a significant decrease in opioid prescriptions without the need for secondary prescriptions following implementation of their consensus protocol developed by 5 orthopedic surgeons. This suggests that there is a clear educational component to this issue pointing to potential knowledge gaps that can be easily corrected through evidence-based programs for surgeons.…”

Section: Discussionmentioning

confidence: 99%

Upper-Extremity Nerve Decompression Under Local Anesthesia: A Systematic Review of Methods for Reduction of Postoperative Pain and Opioid Consumption

Chocron

Aljerian

Thibaudeau

2019

Hand (New York, N,Y.)

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Background: Opioid abuse is a major health concern in North America. Data have shown an alarming increase in opioid-related deaths and complications, which has shed light on current prescription practices across many specialties, including hand surgery. To that end, we sought to conduct a focused literature review to determine the available modalities to decrease postoperative pain and opioid consumption following upper-extremity nerve decompression procedures, taking advantage of the homogeneity and inherent pain pathways of this specific patient cohort. Methods: A systematic review of the literature was conducted. Primary studies evaluating perioperative and intraoperative modalities for postoperative pain reduction and analgesic consumption following upper-extremity nerve decompression procedures under local anesthesia were included. Studies implementing modalities requiring non–hand surgeon expertise (ie, intravenous sedation), as well as studies that include non–nerve decompression procedures, were excluded. Results: A total of 1478 studies were identified, and 9 studies were included after full-text review. Six studies evaluated intraoperative and 3 studies evaluated preoperative and postoperative modalities. Successful interventions included buffered anesthetic, the use of hyaluronidase, and varying techniques and mixtures for anesthetic administration. No successful preoperative or postoperative modalities were identified. Conclusion: Despite data reporting on the dangers associated with current opioid prescription practices, evidence-based modalities to decrease postoperative pain and opioid consumption are limited in general. Several intraoperative modalities do exist, and nonopioid oral analgesics, standardized opioid protocols, and reduced postoperative prescriptions can be used. Large randomized controlled trials evaluating perioperative modalities for pain reduction are needed to further address this issue.

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Section: Discussionmentioning

confidence: 99%

Upper-Extremity Nerve Decompression Under Local Anesthesia: A Systematic Review of Methods for Reduction of Postoperative Pain and Opioid Consumption

Chocron

Aljerian

Thibaudeau

2019

Hand (New York, N,Y.)

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“…Instituting opiate prescription protocols for standard upperextremity surgeries can lead to a substantial reduction in opioid use. 42,43 In addition to written educational handouts to patients, preoperative counseling has been shown to reduce narcotic consumption after surgery. 44…”

Section: Use Of Other Strategies (Regional Blocks Nonsteroidal Anti-mentioning

confidence: 99%

What’s New in the Battle Against the Opioid Crisis in Hand Surgery: A Review

Seigerman

Lutsky

Kwok

et al. 2019

Journal of Hand Surgery Global Online

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The opioid epidemic is the subject of much debate and research within all medical fields. Notable work has been done in hand surgery. The purpose of this article is to review the recent literature as it pertains to opioid use in hand surgery. The scope of the current problem is identified and mitigating strategies are described. More studies are necessary to evaluate the efficacy of these strategies.

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Implementation of a Postoperative Opioid Prescribing Protocol Significantly Reduces Total Morphine Milligram Equivalents Prescribed

Cited by 2 publications

References 0 publications

Upper-Extremity Nerve Decompression Under Local Anesthesia: A Systematic Review of Methods for Reduction of Postoperative Pain and Opioid Consumption

Upper-Extremity Nerve Decompression Under Local Anesthesia: A Systematic Review of Methods for Reduction of Postoperative Pain and Opioid Consumption

What’s New in the Battle Against the Opioid Crisis in Hand Surgery: A Review

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