Opioid Use Among Hand Surgery Patients

There has recently been a load of attention given to opioid use and abuse in the United States.  There is evidence that most patients are being given a lot more medication than they have required to treat potential postoperative pain.  In a large study reported in the Journal of Hand Surgery in 2016, for example, 13% of patients continue to fill prescriptions for opioids between three and six months after surgery.  Interestingly, elective surgery patients are more likely to continue to fill opioid prescriptions after a three-month period compared with trauma patients!

I have found that it is almost never necessary to give patients opioids (hydrocodone, oxycodone, or Codeine, etc.) for hand surgery procedures.  When it is given I limit it to about a one-week supply maximum.  I have found that the best way to help prevent pain and to avoid opioids is to prevent letting a person experience much pain in the first place.  I have extensively used anti-inflammatory medication which interferes with the chemical cascade ultimately perceived by the brain as pain since the mid-1980s.  I have the patient start the anti-inflammatory the night before and continue it full-strength for about a week after surgery.  In the event of breakthrough pain I give them a non-addicting analgesic in the form of tramadol should Tylenol fail to give them the boost in pain relief that they need.   Upon calling the patients the next day I find that most of them have not required even tramadol[1] and so I often suggest to the patients to not fill the prescription in the first place, just have the written prescription as a back-up in the event it is needed.