Chapman Talia, Kim Nayoung, Maltenfort Mitchell, Ilyas Asif M
Thomas Jefferson University Hospital, Philadelphia, PA, USA.
The Rothman Institute, Philadelphia, PA, USA.
Hand (N Y). 2017 Jan;12(1):39-42. doi: 10.1177/1558944716646765. Epub 2016 Apr 29.
Postoperative pain management and opioid consumption following carpal tunnel release (CTR) surgery may be influenced by many variables. To understand factors affecting opioid consumption, a prospective study was undertaken with the hypothesis that CTR performed under local anesthesia (wide awake local anesthesia with no tourniquet [WALANT]) would result in increased opioid consumption postoperatively compared with cases performed under sedation. All patients undergoing open CTR surgery were consecutively enrolled over a 6-month period. Information collected included patient demographics, surgical technique, amount and type of narcotic prescribed, number of pills taken, and type of anesthesia. 277 patients were enrolled (56% women, 44% men). On average, 21 pills were prescribed, and 4.3 pills (median = 2) were consumed. There was no difference in consumption between patients who received WALANT (78 cases) versus (198 cases) sedation (4.9 vs 3.9 pills, respectively) ( = .22). There was no difference in opioid consumption based on insurance type ( = .47) or type of narcotic ( = .85). However, more men consumed no opioids (47%) compared with women (36%) ( < .05) and older patients consumed less than younger patients ( < .05). Opioid consumption following CTR is more influenced by age and gender, and less influenced by anesthesia type, insurance type, or the type of opioid prescribed. Many more opioids were prescribed than needed, on an average of 5:1. Many patients, particularly older patients, do not require any opioid analgesia after CTR.
腕管松解术（CTR）术后的疼痛管理及阿片类药物使用情况可能受多种变量影响。为了解影响阿片类药物使用的因素，我们进行了一项前瞻性研究，假设在局部麻醉下（无止血带的完全清醒局部麻醉[WALANT]）进行的CTR手术与在镇静状态下进行的手术相比，术后阿片类药物使用量会增加。在6个月的时间里，连续纳入了所有接受开放性CTR手术的患者。收集的信息包括患者人口统计学资料、手术技术、开具的麻醉药品数量和类型、服用的药丸数量以及麻醉类型。共纳入277例患者（56%为女性，44%为男性）。平均开具了21粒药丸，服用了4.3粒（中位数 = 2）。接受WALANT的患者（78例）与接受镇静的患者（198例）之间的药物使用量无差异（分别为4.9粒和3.9粒）（P = 0.22）。基于保险类型（P = 0.47）或麻醉药品类型（P = 0.85），阿片类药物使用量无差异。然而，与女性（36%）相比，更多男性未使用阿片类药物（47%）（P < 0.05），老年患者的使用量少于年轻患者（P < 0.05）。CTR术后阿片类药物的使用更多地受年龄和性别的影响，而受麻醉类型、保险类型或开具的阿片类药物类型的影响较小。开具的阿片类药物数量平均是所需数量的5倍，远超过实际需求。许多患者，尤其是老年患者，CTR术后不需要任何阿片类镇痛药物。
