Postoperative Pain Level Following Surgery of the Hand and Wrist in the Ambulatory Setting

Abstract

Background Surgical procedures of the hand are increasingly performed in an ambulatory setting. Postoperative analgesia is based empirically on the painfulness of individual surgical procedures without these having been examined systematically.

Patients and Methods The painfulness (visual analogue scale) of 722 surgical procedures of the hand and wrist (1 July 2021 to 30 June 2023) was assessed until day 5. Analgesia was conducted empirically in accordance with WHO principles. The primary endpoint was the pain sensation on the first postoperative day in bone and joint procedures compared with soft tissue or endoscopic procedures as well as hardware removals. Secondary endpoints were pain sensation in correlation with gender, age, duration of the procedure and preoperative analgesia.

Results Bone and joint procedures were associated with significantly (p<0.001) more pain (5.42±2.8) compared with other procedures (3.47±2.6). Female (p=0.001) and younger patients (R>0.2) as well as longer procedure duration (R>0.2) showed a weak association with higher postoperative pain, whereas preoperative consumption of opioids was moderately associated with higher opioid intake (R=0.34). Overall, pain decreased continuously from the evening of the procedure (4.4±2.8) until day 5 (3.7±2.7; 2.8±2.4; 2.1±2.1; 1.6±1.9; 1.3±1.7)

Conclusion This data provides a scientific basis for pain medication supply following surgical procedures of the hand and wrist in an ambulatory setting. A broad range of pain perception must be considered, even in seemingly minor surgical procedures.

Keywords

analgesia - wrist surgery - thumb basal joint osteoarthritis - carpal tunnel syndrome - aponeurectomy

Publication History

Received: 23 July 2024

Accepted: 27 September 2024

Article published online:
13 November 2024

• Literatur

• 1 Gauger EM, Gauger EJ, Desai MJ. et al. Opioid use after upper extremity surgery. J Hand Surg [Am] 2018; 43: 470-479
• 2 Dowell D, Noonan RK, Houry D. Underlying factors in drug overdose deaths. JAMA 2017; 318: 2295-2296
• 3 Lux EA, Stamer U, W, Meissner W, et al. Postoperative Schmerztherapie nach ambulanten Operationen. Schmerz 2011; 25: 191-198
• 4 Menendez ME, Ring D. Emergency department visits after hand surgery are common and usually related to pain or wound issues. Clin Orthop Relat Res 2016; 474: 551-556
• 5 Rodgers J, Cunningham K, Fitzgerald K. et al. Opioid Consumption Following Outpatient Upper Extremity Surgery. J Hand Surg [Am] 2012; 37: 645-650
• 6 Teunis T, Stoop N, Park CJ. et al. What factors are associated with a second opioid prescription after treatment of distal radius fractures with a volar locking plate?. Hand (NY) 2015; 10: 639-648
• 7 Alter TH, Ilyas AM. A prospective randomized study analyzing preoperative opioid counseling in pain management after carpal tunnel release surgery. J Hand Surg [Am] 2017; 42: 810-815
• 8 Chapman T, Kim N, Maltenfort M. et al. Prospective Evaluation of Opioid Consumption Following Carpal Tunnel Release Surgery. Hand (NY) 2017; 12: 39-42
• 9 Miller A, Kim N, Zmistowski B. et al. Postoperative pain management following carpal tunnel release: A prospective cohort evaluation. Hand (NY) 2017; 12: 541-545
• 10 Baumbach P, Dreiling J, Arnold C. et al. Pain after outpatient surgical procedures—a survey of 330 000 patients. Dtsch Arztebl Int 2024; 121: 71-78
• 11 Ilyas AM, Miller AJ, Graham JG. et al. A prospective, randomized, double-blinded trial comparing Acetaminophen, Ibuprofen, and Oxycodone for pain management after hand surgery. Orthopedics 2019; 42: 110-115
• 12 Giuliani E, Bianchi A, Marcuzzi A. et al. Ibuprofen timing for hand surgery in ambulatory care. Acta Ortop Bras 2015; 23: 188-191
• 13 Waljee JF, Zhong L, Hou H. et al. The use of opioid analgesics following common upper extremity surgical procedures: a national, population-based study. Plast Reconstr Surg 2016; 137: 355e-364e
• 14 Wong KA, Goyal KS. Postoperative pain management of non-“opioid-naive” patients undergoing hand and upper-extremity surgery. Hand (NY) 2020; 15: 651-658
• 15 Gaddis A, Dowlati E, Apel PJ. et al. Effect of prescription size on opioid use and patient satisfaction after minor hand surgery. Ann Surg 2019; 270: 976-982
• 16 Löw S, Herold D, Eingartner C. Der “wide-awake approach” -Effizienz und Patientensicherheit bei der Karpaldachspaltung. Handchir Microchir Plast Chir 2013; 45: 271-274
• 17 Löw S, Herold A, Eingartner C. Die standardisierte Arthroskopie des Handgelenks. Oper Orthop Traumatol 2014; 26: 539-546
• 18 Löw S, Kiesel S. Standardisierte Reposition und palmare Plattenosteosynthese dorsal dislozierter distaler Radiusfrakturen zur sicheren und atraumatischen Wiederherstellung der Radiusanatomie. Oper Orthop Traumatol 2024; 36: 223-234