Kent Weinheimer1, Brett Michelotti2, Jeremy Silver3, Kenneth Taylor3, Alexander Payatakes3. 1. Department of Orthopaedic Surgery, Penn State Hershey Medical Center, Hershey, PA. Electronic address: kentwein2007@gmail.com. 2. Division of Plastic Surgery, Penn State Hershey Medical Center, Hershey, PA. 3. Department of Orthopaedic Surgery, Penn State Hershey Medical Center, Hershey, PA.
Abstract
PURPOSE: To compare the efficacy of opioid versus nonopioid analgesic regimens after elective, soft tissue hand surgery. We hypothesized that there would be no difference in patient-perceived pain relief between these 2 groups. METHODS: This prospective, randomized, double-blinded controlled trial included patients undergoing elective soft tissue hand procedures (carpal tunnel release, trigger finger release, first dorsal compartment release, or ganglion cyst excision). Patients were randomized before surgery into 2 treatment groups: acetaminophen/hydrocodone 325/5 mg (AH, opioid group) or acetaminophen/ibuprofen 500/400 mg (AIBU, nonopioid group) and followed for 2 weeks after surgery evaluating daily pain intensity scores-visual analog scale (VAS), medication pain relief (Likert pain relief score), need for rescue opioid prescription at 1 week, and days until pain-free. RESULTS:Sixty patients were randomized, 30 in the AH group and 30 in the AIBU group. There was no difference in the average VAS score. There was improved pain relief in the AIBU group, but the difference did not reach significance. There was no difference in time until pain-free, with a median of 5 days in the AH group and 3 days in the AIBU group. Two patients in each group required rescue opioid medication. Side effects were significantly more common in the AH group (n = 7; 23%) than the AIBU group (n = 1; 3%), but none were severe. CONCLUSIONS: We recommend surgeons consider a combination of acetaminophen and ibuprofen as a safe and effective postoperative pain regimen for soft tissue hand surgery procedures. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
RCT Entities:
PURPOSE: To compare the efficacy of opioid versus nonopioid analgesic regimens after elective, soft tissue hand surgery. We hypothesized that there would be no difference in patient-perceived pain relief between these 2 groups. METHODS: This prospective, randomized, double-blinded controlled trial included patients undergoing elective soft tissue hand procedures (carpal tunnel release, trigger finger release, first dorsal compartment release, or ganglion cyst excision). Patients were randomized before surgery into 2 treatment groups: acetaminophen/hydrocodone 325/5 mg (AH, opioid group) or acetaminophen/ibuprofen 500/400 mg (AIBU, nonopioid group) and followed for 2 weeks after surgery evaluating daily pain intensity scores-visual analog scale (VAS), medication pain relief (Likert pain relief score), need for rescue opioid prescription at 1 week, and days until pain-free. RESULTS: Sixty patients were randomized, 30 in the AH group and 30 in the AIBU group. There was no difference in the average VAS score. There was improved pain relief in the AIBU group, but the difference did not reach significance. There was no difference in time until pain-free, with a median of 5 days in the AH group and 3 days in the AIBU group. Two patients in each group required rescue opioid medication. Side effects were significantly more common in the AH group (n = 7; 23%) than the AIBU group (n = 1; 3%), but none were severe. CONCLUSIONS: We recommend surgeons consider a combination of acetaminophen and ibuprofen as a safe and effective postoperative pain regimen for soft tissue hand surgery procedures. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
Authors: Bryan A Hozack; Michael Rivlin; Kevin F Lutsky; Jack Graham; Ludovico Lucenti; Carol Foltz; Pedro K Beredjiklian Journal: Clin Orthop Relat Res Date: 2019-06 Impact factor: 4.176
Authors: Dustin T Crystal; Ahmed M S Ibrahim; Louise L Blankensteijn; Nicholas G Cuccolo; Darya Kazei; Helen S Zitkovsky; Bernard T Lee; Samuel J Lin Journal: Plast Reconstr Surg Glob Open Date: 2021-11-16
Authors: Kyra A Benavent; Nomee D Altschul; Lindsay F Lincoln; Cassandra M Chruscielski; Kevin F Kennedy; Brandon E Earp Journal: J Hand Surg Glob Online Date: 2020-05-11
Authors: Corey C Spencer; Jeremiah A Pflederer; Jacob M Wilson; Alexander M Dawes; Michael B Gottschalk; Eric R Wagner Journal: JSES Int Date: 2021-04-03