gms | German Medical Science

Objectives/Interrogation: In recent years, there has been an exponential increase in opioid prescriptions provided to patients, leading to the current "opioid epidemic." We have instituted opioid-restricting, postoperative analgesic measures. We hypothesized that patients' reported VAS pain scale would be lower postoperatively, obviating the need for postoperative opioid analgesics, and that patient-specific factors would not impact this hypothesis.

Methods: Consecutive patients from a single, fellowship-trained hand surgeon from July 2017 - January 2018 undergoing soft tissue hand/upper extremity procedures were selected. All patients under 18 years of age were excluded. All surgeries were performed using the Wide Awake Local Anesthesia No Tourniquet (WALANT) technique. Univariate analysis (paired two-tailed t-test) was employed to compare patients' preoperative VAS pain scores to postoperative scores at postoperative day (POD)1 and POD14. Scores were also compared between POD1 and POD14. All statistical testing was performed using IBM SPSS v.24.0. Furthermore, each patient's Charlson Comorbidity Index (CCI) was calculated and reported.

Results and Conclusions: A total of 36 patients underwent 40 soft tissue procedures. The mean age of patients was 49.3 years (range, 14 to 81 years), with a 2:1 female to male ratio and mean BMI of 31.8 kg/m2. A large proportion of patients were African American (n=31, 86.1%) and were insured by Medicaid (n=18, 50%); four patients (11.1%) were insured by Medicare. Mean CCI for these patients was 2.36. The most common procedure performed was trigger finger release (n=12), followed by carpal tunnel release (n=10, 25%). Compared to mean preoperative score (3.36), mean VAS pain scores at POD1 (1.53) and POD14 (0.22) significantly decreased (p<0.001). Furthermore, mean VAS pain score decreased significantly (p<0.001) at POD14 when compared to POD1. Of note, only one patient was prescribed opioid analgesia between discharge and POD14 (from the emergency department). In conclusion, patients' mean reported pain following soft tissue hand/upper extremity procedures with WALANT and opioid restriction declined from pre- to postoperative time-points, with a substantial decrease also found between POD1 and POD14 time-points. In the medically disadvantaged population we serve, this postoperative analgesic regimen had acceptable outcomes and could be employed safely as a possible treatment plan in a medically-underserved area and for patients with considerable morbidity and mortality risk.