Prospective Evaluation of Opioid Utilization After Upper Extremity Surgery: Determining Consumption Patterns and Developing Prescribing Guidelines

A Prospective Randomized Study Analyzing Preoperative Opioid Counseling in Pain Management After Carpal Tunnel Release Surgery

“…As this issue continues to garner attention from the medical community, more physicians have begun implementing opioid counseling prior to surgeries. 6 Overall, opioid consumption was low in both groups, 1.40 v 4.20 opioid pills in the counseling and non-counseling groups, but was consistent with the findings by Chapman et al who identified an average opioid consumption of 4.3 pills after CTR surgery. 11 In our analysis of pre-operative opioid counseling prior to CTR surgery, we found that patients with counseling consumed significantly less prescribed opioid pills than the patients with counseling on the day of surgery, on the first post-operative day, and in total over the course of the study (Table 2).…”

“…6,10 Specifically, 76% of patients undergoing CTR surgery have filled at least one prescription for opioid analgesics and 14% have filled a prescription beyond 90 days postoperatively. 4 With a recent national focus on the increasing abuse of prescription opioids in the United States, the use and effectiveness of pre-operative opioid counseling has come under investigation.…”

“…4 Despite the already high rate of opioid use following common orthopedic surgeries, opioid prescribing for orthopedic surgeries continues to increase and inadvertent over-prescribing is a common phenomenon. [5][6] Various methods have been explored to decrease the misuse and abuse of prescription opioids in the past decade. One such method is pre-operative "opioid counseling," which consists of educating patients on the effects and risks of opioid use, recommending appropriate opioid usage, and discussing alternative non-opioid pain treatment options.…”

Editorial: The Opioid Epidemic and Orthopaedic Surgery—No Pain, Who Gains?

“…Others attribute the problem to advocacy groups that recommended ''getting pain to zero,'' and to aggressive marketing by pharmaceutical companies that unrealistically minimized the risks associated with these drugs [20]. And as much as we might like to attribute the problem to family doctors who prescribe narcotics for chronic conditions like arthritis, or to for-pay pain clinics that spring up like mushrooms after the rain, in fact our specialty is deeply involved [14,29], and orthopaedic patients are at risk.…”

“…We do know that orthopaedic surgeons prescribe far more narcotics than patients use [14]; the opioids for sale on the street come from somewhere. Too often, we just don't see the harms we cause.…”