Babiker-Moore Tahra, Clark Carol J, Kavanagh Emma, Crook Timothy B
Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK.
South Wing E1 Orthopaedic Outpatients, Dorset County Hospital, Dorchester, UK.
Hand Ther. 2025 Mar;30(1):19-33. doi: 10.1177/17589983241301449. Epub 2024 Dec 2.
Hand surgery is commonly required for conditions like Dupuytren's disease, carpal tunnel syndrome, and carpometacarpal osteoarthritis. Hand experts agree that patient education and managing expectations can optimise surgical outcomes. With an aging population, and rising rates of diabetes and obesity, a significant increase in elective hand surgeries is anticipated over the next decade.
To assess the effectiveness of preoperative therapy interventions on improving postoperative outcomes following elective hand surgery.
A systematic search of six databases accessed journals from January 2011 to April 2024. Included studies assessed postoperative outcomes following preoperative therapy intervention.
Seven articles met the inclusion criteria: six randomised controlled trials (RCTs) and one retrospective cohort study. Five RCTs explored effects of opioid education on postoperative consumption, all reporting statistically significant differences in favour of the intervention, with one showing a decrease of 49.7 morphine equivalent units (95% CI: 11.9 to 87.5), representing a 34.7% decrease between intervention and control. All RCTs scored poorly for risk of bias with the exception of one which assessed the effects of a neuroscience pain education on postoperative pain, reporting a non-significant decrease of 7.7% favouring the control.
There is a lack of quality research assessing preoperative interventions and outcomes for hand surgery. There was some indication of favourable outcomes following preoperative opioid education; however, number of studies were small, the evidence quality was poor, and data were limited. Further research is required to address these gaps and identify the most effective preoperative interventions.
诸如掌腱膜挛缩症、腕管综合征和腕掌关节骨关节炎等病症通常需要进行手部手术。手部专家一致认为，患者教育和管理预期可以优化手术效果。随着人口老龄化以及糖尿病和肥胖率的上升，预计在未来十年择期手部手术将显著增加。
评估术前治疗干预措施对改善择期手部手术后的术后效果的有效性。
对六个数据库进行系统检索，检索2011年1月至2024年4月期间的期刊。纳入的研究评估了术前治疗干预后的术后效果。
七篇文章符合纳入标准：六篇随机对照试验（RCT）和一篇回顾性队列研究。五篇RCT探讨了阿片类药物教育对术后用量的影响，所有研究均报告干预组有统计学显著差异，其中一项研究显示吗啡当量减少49.7单位（95%CI：11.9至87.5），干预组与对照组相比减少了34.7%。除了一项评估神经科学疼痛教育对术后疼痛影响的研究外，所有RCT的偏倚风险评分都很低，该研究报告对照组有7.7%的非显著减少。
缺乏评估手部手术术前干预措施和效果的高质量研究。有迹象表明术前阿片类药物教育后有良好效果；然而研究数量较少，证据质量较差，数据有限。需要进一步研究来填补这些空白，并确定最有效的术前干预措施。
