Purpose
For outpatient hand and upper-extremity surgeries, opioid prescriptions may exceed
the actual need for adequate pain control. The purposes of this study were to (1)
determine rates of opioid wasting and consumption after these procedures and (2) create
and implement a patient-specific calculator for opioid requirements with a detailed
multimodal analgesic plan to guide postoperative prescriptions.
Methods
Patients undergoing hand and upper-extremity surgery at a single ambulatory surgery
center were recruited before (n = 305) and after (n = 221) implementation of a postoperative
pain control program. On the first postoperative visit, patients were given a questionnaire
regarding opioid use and pain control satisfaction. Demographic and procedural data
were collected via chart review. With these data from the first cohort, we developed
a patient-specific opioid calculator and pain plan that was implemented for the second
cohort of patients. Bivariate analysis and multivariable regression analysis were
used to determine the effect of the intervention.
Results
Pre-intervention data suggested that younger age; baseline opioid use; use of regional
block; unemployment; procedures involving bony, tendinous, or ligamentous work (as
opposed to soft tissue alone); and longer procedure time were predictive of higher
opioid consumption. Pre- and post-intervention cohorts had similar age and sex distributions
as well as procedure length. After the intervention, opioids prescribed decreased
63% from a mean of 32.0 ± 15.0 pills/surgery or 194.5 ± 120.2 morphine milligram equivalents
(MMEs) to 11.7 ± 8.9 pills/surgery or 86.4 ± 67.2 MMEs. Opioid consumption decreased
58% from a mean of 21.7 ± 25.0 pills/surgery (137.7 ± 176.4 MMEs) to 9.3 ± 16.7 (64.4
± 113.4 MMEs). Opioid wastage decreased 62% from 13.8 ± 13.5 pills/surgery (62.8 ±
138.0 MMEs) to 5.2 ± 10.3 (24.8 ± 89.9 MMEs). Implementation of the pain plan and
calculator did not affect the odds of unsatisfactory patient-rated pain control or
unplanned opioid refills.
Conclusions
With implementation of a comprehensive pain plan for ambulatory upper-extremity surgery,
it is possible to reduce opioid prescription, consumption, and wastage rates without
compromising patient satisfaction with pain control or increasing rates of unplanned
pain medication refills.
Type of study/level of evidence
Therapeutic II.
Key words
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Article Info
Publication History
Accepted:
October 1,
2019
Received:
August 14,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
