Prolonged Opioid Use following Hand Surgery: A Systematic Review and Proposed Criteria

Abstract

Background: Prolonged opioid use after surgery has been a contributing factor to the ongoing opioid epidemic. The purpose of this systematic review is to analyze the definitions of prolonged opioid use in prior literature and propose appropriate criteria to define postoperative prolonged opioid use in hand surgery. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines 130 studies were included for review. The primary outcome was the timepoint used to define prolonged opioid use following surgery. The proportion of patients with prolonged use and risk factors for prolonged use were also collected for each study. Included studies were categorized based on their surgical specialty. Results: The most common timepoint used to define prolonged opioid use was 3 months (n = 86, 67.2% of eligible definitions), ranging from 1 to 24 months. Although 11 of 12 specialties had a mean timepoint between 2.5 and 4.17 months, Spine surgery was the only outlier with a mean of 6.90 months. No correlation was found between the definition’s timepoint and the rates of prolonged opioid use. Conclusions: Although a vast majority of the literature reports similar timepoints to define prolonged postoperative opioid use, these studies often do not account for the type of procedures being performed. We propose that the definitions of postoperative prolonged opioid use should be tailored to the level and duration of pain for specific procedures. We present criteria to define prolonged opioid use in hand surgery.

Antineuropathic Pain Management After Orthopedic Surgery: A Systematic Review

“…7 Therefore, identifying alternative methods to manage postoperative pain has become an area of active research. 8 With the current opioid epidemic, attention has shifted to a multimodal analgesic approach to minimize unnecessary opioid consumption. Multimodal analgesia is the use of multiple medications with different mechanisms of action, with the goal of improving pain relief with less side effects compared with a single class of medication.…”

Overuse of the psychoactive analgesics’ opioids and gabapentinoid drugs in patients having surgery for nerve entrapment disorders

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“…Previous studies have shown an increased risk for opioid overuse after different surgical procedures [1][2][3][4][5] . Following surgery, approximately 10% of patients develop persistent pain, leading to impaired quality of life and eventually to psychiatric conditions, such as anxiety and depression.…”