gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Postoperative pain management to the patients with distal radial fractures without opioid

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  • presenting/speaker Jeonghwan Kim - Seoul Medical Center, Seoul, South Korea
  • Young Ju Chae - Seoul Medical Center, Seoul, South Korea

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-812

doi: 10.3205/19ifssh1110, urn:nbn:de:0183-19ifssh11102

Published: February 6, 2020

© 2020 Kim et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Postoperative pain control(PPC) to the patients is becoming more important practical issue that affects patient satisfaction, surgical outcome and safety. Many drugs were prescribed for PPC. However, the term 'Opioid Epidemic'is being used as the prescription of opioid has rapidly increased and raised the issue of opioid abuse. And the higher rate of opioid side effects in elders is a new problem that may require a longer hospitalization period. Therefore, PPC without opioid is becoming more important issue. The surgery to distal radius fracture (DRF) is one of the most common hand surgeries. Therefore, if PPC without opioid was possible in DRF patients, the opioid use in hand surgery might be considerably decreased. We hypothesized that PPC with non-opoid drugs could be sufficient for the patients with distal radial fractures.

Methods: Patients who scheduled for DRF surgery were the subjects of this study. Patients chose their anesthesia method between GA or BPB according to their own preferences. They were prescribed 2g of IV propacetamol every 6hours after surgery. Additional 1g of IV propacetamol was prescribed for patients who complained of pain beyond VAS 3. And 50mg of tramadol was prescribed for the patients with uncontrolled pain by propacetamol.

We evaluated the pain experience of each patient 8 times from preoperative period (P0) to postoperative (P) 48 hours with VAS scale and the request for additional analgesics.

Results and Conclusions: To date, 55 patients have been enrolled in this study. And 43 patients chose BPB, and twelve patients chose GA. In BPB group, additional prescription of propacetamol except every 6-hour use was 49 times in 42 patients (97%), and the time of request of additional propacetamol were 5 at P3H, 31 at P6H, and 13 at P12H. In GA group, additional additional prescription of propacetamol except routine 6-hour use was 20g in all 12 patients, the time of request of additional propacetamol were 1 at P1H, 4 at P2H, 6 at P3H, 5 at P2 6H, and 4 at P12H. Tramadol was used in 8 patients (18%) in BPB group, and in 1 patient (10%) in GA group. There was no further request for additional analgesics after P24H. And there was no patient who needed tramadol prescription more than once.

In this study, pain of 82% of the patients in BPB group and 90% of the patients in GA group were successfully controlled without any opioid use. We believe that the use of non-opioids could be sufficient not to all, but to most of the DRF patients for their postoperative pain management.