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. 2017 Jan;12(1):39-42.
doi: 10.1177/1558944716646765. Epub 2016 Apr 29.

Prospective Evaluation of Opioid Consumption Following Carpal Tunnel Release Surgery

Talia Chapman  1 , Nayoung Kim  2 , Mitchell Maltenfort  2 , Asif M Ilyas  2
Affiliations

Prospective Evaluation of Opioid Consumption Following Carpal Tunnel Release Surgery

Talia Chapman et al. Hand (N Y). 2017 Jan.

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.

Keywords: carpal tunnel release; narcotic usage; opioid consumption; outpatient surgery; soft tissue procedure.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Comparing narcotic consumption in open CTR for WALANT versus MAC sedation. Note. There was no statistical difference in the mean number of opioid pills consumed between those who had WALANT versus MAC anesthesia (4.98 vs 3.94 pills, P = .22). CTR = carpal tunnel release; WALANT = wide awake local anesthesia with no tourniquet; MAC = monitored anesthesia care.
Figure 2.
Figure 2.
Analysis of opioid consumption based on insurance type. Note. There was no difference in average opioid consumption when we compared insurance type: Patients with private insurance consumed 4.67 pills compared with 3.72 pills for Medicare patients and 3.62 pills for worker’s compensation patients (WC) (P = .47).
Figure 3.
Figure 3.
Analysis of opioid consumption based on opioid prescribed. Note. No statistically significant difference in average opioid consumption was identified between patients who consume Percocet (4.4) versus Tylenol 3 (4.1) versus Vicodin (3.9) versus Hydrocodone (4.6) (P = .85).
Figure 4.
Figure 4.
Analysis of opioid consumption based on gender. Note. There was also no statistical difference when we compared the average number of pills consumed by women versus men (4.2 vs 4.3, P = .86; Figure 4).
Figure 5.
Figure 5.
Analysis of opioid consumption based on age. Note. On average, patients aged between 20 and 39 years took 8.13 pills, patients aged 40 to 59 took 4.89 pills, patients aged 60 to 79 took 3.97 pills, and patients older than 80 took only 2.45 (P < .02).
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References

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