TY  - BOOK
AU  - El Masry, Seif
AU  - Giladi, Aviram M
AU  - Lawson, Jonathan
AU  - Ngaage, Ledibabari M
TI  - Efficacy of Postoperative Opioid-Sparing Regimens for Hand Surgery: A Systematic Review of Randomized Controlled Trials
SN  - 0363-5023
PY  - 2024///
KW  - *Analgesics, Opioid
KW  - *Hand
KW  - *Pain, Postoperative
KW  - *Patient Satisfaction
KW  - *Randomized Controlled Trials as Topic
KW  - Analgesics, Non-Narcotic/tu [Therapeutic Use]
KW  - Analgesics, Opioid/tu [Therapeutic Use]
KW  - Hand/su [Surgery]
KW  - Humans
KW  - Pain Management/mt [Methods]
KW  - Pain Measurement
KW  - Pain, Postoperative/dt [Drug Therapy]
KW  - Automated
KW  - Curtis National Hand Center
KW  - Journal Article
KW  - Systematic Review
N1  - Available in print through MWHC library: 1999 - 2002, Available online from MWHC library: 1995 - present
N2  - CONCLUSIONS: Opioid-sparing regimens provide adequate pain relief for most upper extremity surgery patients. However, a meaningful number of patients on opioid-sparing regimens required greater medication refills and increased use of rescue analgesia. These patients also reported no difference in satisfaction compared with limited/nonopioid regimens; METHODS: We aimed to systematically review randomized controlled trials of opioid-sparing approaches in upper extremity surgery. An initial search of studies evaluating opioid-sparing regimens after upper extremity surgery from the elbow distal yielded 1,320 studies, with nine meeting inclusion criteria. Patient demographics, surgery type, postoperative pain regimen, satisfaction measurements, and number of patients inadequately treated within each study were recorded. Outcomes were assessed using descriptive statistics; PURPOSE: Multiple interventions have been implemented to reduce opioid prescribing in upper extremity surgery. However, few studies have evaluated pain relief and patient satisfaction as related to failure of these protocols. We sought to evaluate the efficacy of limited and nonopioid ("opioid-sparing") regimens for upper extremity surgery as it pertains to patient satisfaction, pain experienced, and need for additional refills/rescue analgesia; RESULTS: Nine randomized controlled trials with 1,480 patients were included. Six of nine studies (67%) reported superiority or equivalence of pain relief with nonopioid or limited opioid regimens. However, across all studies, 4.2% to 25% of patients were not adequately treated by the opioid-sparing protocols. This includes four of seven studies (57%) assessing number of medication refills or rescue analgesia reporting increased pill consumption, refills, or rescue dosing with limited/nonopioid regimens. Five of six studies (83%) reporting satisfaction outcomes found no difference in satisfaction with pain control, medication strength, and overall surgical experience using opioid-sparing regimens; TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II. Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved
UR  - https://dx.doi.org/10.1016/j.jhsa.2024.02.007
ER  -