title: Management of Acute Postoperative Pain in Hand Surgery: A Systematic Review.
abstract: OBJECTIVE
  To conduct a systematic review to guide hand surgeons in an evidenced-based approach in managing postoperative pain.
  
  
  METHODS
  We performed a literature review for primary research articles on management of postoperative pain in hand surgery patients using Medical Literature Analysis and Retrieval System Online (MEDLINE; PubMed), Excerpta Medica database (EMBASE), and the Cochrane Collaboration Library. Inclusion criteria were primary journal articles examining treatment of acute postoperative pain based on any modality. Data related to pain assessment, postoperative recovery, and total postoperative analgesic consumption were extracted.
  
  
  RESULTS
  A total of 903 publications were reviewed; 184 publications underwent abstract review. After applying inclusion and exclusion criteria, 10 primary articles were selected for inclusion in this review. Data were noted to be heterogeneous and findings were compiled. Results were divided into groups evaluating postoperative pain medications or pain infusion catheters.
  
  
  CONCLUSIONS
  Although this review did not demonstrate a best practices model for postoperative pain management, it provides evidence for alternative medications and treatment strategies. The evidence available suggests that postoperative pain control should begin before surgery and that combining multiple strategies for pain treatment is beneficial. Given the increasing attention paid to narcotic prescriptions and the potential for abuse, surgeons should adopt evidence-based pain management practices. We provide an example algorithm for pain treatment in hand surgery based on available data and the authors' experience.
  
  
  METHODS
  Therapeutic III.
authors.affiliation: Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Kelley
authors.affiliation: Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Shauver
authors.affiliation: Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI. Electronic address: kecchung@med.umich.edu.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
mesh_terms: D059787:Acute Pain; D006225:Hand / Q000601:surgery*; D006801:Humans; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*
keywords: Analgesia; hand surgery; opiate; postoperative pain