Two new studies presented at the 2018 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) demonstrated that pre-operative counseling resulted in a significant decrease in opioid use after hand surgery, and patients who used non-opioid pain relievers following surgery experienced a similar pain experience and benefit with fewer adverse events than those that received opioids. Both studies were conducted at the Rothman Institute at Thomas Jefferson University in Philadelphia and focused on pain management following carpal tunnel release (CTR) or trigger finger release (TFR) surgery.
“We know that normal opioid use to manage patients’ post-operative pain is resulting in the inadvertent consequence of opioid addiction and abuse,” said Asif Ilyas, MD, lead author, program director of the Hand Surgery Fellowship at the Rothman Institute and professor of othopaedic surgery at the Sidney Kimmel Medical College at Thomas Jefferson University. “The spirit of my work is to find mechanisms to prescribe opioids more carefully, while also evaluating strategies that can ultimately reduce patients’ need for them, and ultimately decrease the rate and risk of abuse and addiction. The most surprising result of our counseling study was that there was a two-thirds reduction in opioid use with simple counseling. Once patients were made aware of the risks, benefits and the safest ways to take opioids, they sought and pursued alternatives. In addition, the actual pain experience was no different between the study groups.”
In short, patients in the counseling group used a significantly lower number of total pain pills (two-thirds less) over the course of the study than the group who did not receive counseling, while having an overall equivalent pain experience as the no counseling group.
“Counseling is a very simple thing to do,” said Dr. Ilyas. “There is nothing required beyond time and educational material. Since completion of this study, I now provide formal pre-surgical opioid counseling 100 percent of the time.”
The second study—”Fighting the Opioid Epidemic: A Prospective Randomized Controlled Double-Blinded Trial Comparing Acetaminophen, Ibuprofen, and Oxycodone after Hand Surgery”—evaluated the efficacy of non-opioid drugs, ibuprofen and acetaminophen to manage pain following CTR or TFR. Patients scheduled to undergo CTR or TFR under local anesthesia were randomized to receive 10 de-identified capsules of either oxycodone 5mg, ibuprofen 600mg or acetaminophen 500mg after surgery. Both the surgeon and the patients were blinded as to which medication the patient received.
The average total pills consumed following surgery (zero-five days) was 2.9 of oxycodone, 4.4 of ibuprofen and 3.1 of acetaminophen (p>0.8). Pain experienced post-operatively was recorded, and the average pain scores for the oxycodone, ibuprofen and acetaminophen groups were 1.6, 1.3 and 1.4, respectively (p>0.15). There was also no difference in adverse events or requests for different or stronger medications in either group. In short, there was no difference in pain experience and pill consumption if a blinded patient received oxycodone, ibuprofen, and acetaminophen.
“Our goal is to challenge the mindset of the absolute need for opioids following surgery. With studies like these identifying that non-opioids can be effective in post-operative pain, we can take steps toward moving away from the aggressive opioid prescribing habit that we suffer from as prescribers and that patients also expect,” said Ilyas.
(Source: American Academy of Orthopaedic Surgeons)