title: Prospective Evaluation of Opioid Consumption Following Carpal Tunnel Release Surgery.
abstract: Background:Postoperative pain management and opioid consumption following carpal tunnel release (CTR) surgery may be influenced by many variables. To understand factors affecting opioid consumption, a prospective study was undertaken with the hypothesis that CTR performed under local anesthesia (wide awake local anesthesia with no tourniquet [WALANT]) would result in increased opioid consumption postoperatively compared with cases performed under sedation.Methods:All patients undergoing open CTR surgery were consecutively enrolled over a 6-month period. Information collected included patient demographics, surgical technique, amount and type of narcotic prescribed, number of pills taken, and type of anesthesia.Results:277 patients were enrolled (56% women, 44% men). On average, 21 pills were prescribed, and 4.3 pills (median = 2) were consumed. There was no difference in consumption between patients who received WALANT (78 cases) versus (198 cases) sedation (4.9 vs 3.9 pills, respectively) (P= .22). There was no difference in opioid consumption based on insurance type (P= .47) or type of narcotic (P= .85). However, more men consumed no opioids (47%) compared with women (36%) (P< .05) and older patients consumed less than younger patients (P< .05).Conclusions:Opioid consumption following CTR is more influenced by age and gender, and less influenced by anesthesia type, insurance type, or the type of opioid prescribed. Many more opioids were prescribed than needed, on an average of 5:1. Many patients, particularly older patients, do not require any opioid analgesia after CTR.
authors.affiliation: Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Talia
authors.initials: T
authors.lastname: Chapman
authors.affiliation: The Rothman Institute, Philadelphia, PA, USA.
authors.forename: Nayoung
authors.initials: N
authors.lastname: Kim
authors.affiliation: The Rothman Institute, Philadelphia, PA, USA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Maltenfort
authors.affiliation: The Rothman Institute, Philadelphia, PA, USA.
authors.forename: Asif M
authors.initials: AM
authors.lastname: Ilyas
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000758:Anesthesia / Q000379:methods; D002349:Carpal Tunnel Syndrome / Q000601:surgery*; D016292:Procedural Sedation; D004334:Drug Administration Schedule; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D012737:Sex Factors; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: carpal tunnel release; narcotic usage; opioid consumption; outpatient surgery; soft tissue procedure