Ambulatory Hand Surgery
Conditions
Brief summary
There is a current opioid epidemic in the United States partially fueled by excess prescribing practices after surgery. The objective of this study is to decrease the amount of opioids needed after ambulatory hand surgery. In this randomized control trial, patients will be randomized into a patient education group and into a control group. The education group will be provided with a pre-operative video detailing proper indications for opioid use after hand surgery, alternative pain management strategies to try before using prescription opioid medications, and side effects associated with opioid use. Patients will also receive information on the current opioid epidemic. Patients will be reminded of the information given pre-operatively after surgery in the post-anesthesia care unit. The control group will not receive pre-operative education and will only receive standard of care post-operative counseling by nursing in the post-anesthesia care unit. All patients will be given a pain log, pain medication diary and participate in phone/email surveys to determine number of opioid pills taken, pain levels, and satisfaction with surgery. The investigators hypothesize that the education group will have decreased opioid intake and increased patient satisfaction compared to the control group.
Interventions
BEHAVIORALPatient education regarding indications for opioid use and side effects of opioid use after hand surgery
Patients in the active education group will be given information pre-operatively on the current opioid epidemic, alternative pain management strategies that should be tried before proceeding to prescription opioid use, appropriate indications for opioid use, and side effects of opioids.This information will be reinforced by the research coordinator and nursing staff in the post-anesthesia care unit.
OTHERStandard of care post-operative counseling
Patients will receive standard of care post-operative counseling. They will not be given pre or post-operative opioid education.
Sponsors
Hospital for Special Surgery, New York
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* English Speaking: must be able to communicate over the phone or by email to perform questionnaires * Primary elective ambulatory hand surgery (bony or soft tissue) Bony: Scaphoidectomy/ligament reconstruction tendon interposition (LRTI), Arthrodesis, Arthroplasty Soft Tissue: Carpal tunnel release (CTR), Trigger Finger (TF), DeQuervain's (DQ), Cyst removal, Cubital tunnel, Dupuytren's, tendon transfer, arthroscopy of wrist or elbow
Exclusion criteria
* Disability or preop pain in ipsilateral upper extremity from a secondary condition not related to the study procedure * Allergy or inability to consume oxycodone, Percocet or Vicodin due to a particular health state * Current Substance Abuse * HSS employees
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Number of prescription opioids used postoperatively | Within 14 days of surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain level | Post-op day 3, 8, 15 | Numeric Rating Scale pain scores |
| Surgical factors | Recorded on day of surgery | Type of surgery, length of surgery, type and amount of anesthesia |
| Pain Catastrophization Score | Measured pre-operatively | This validated scale is one of the most widely used instruments to evaluate catastrophic thinking related to pain. It specifically evaluates patients' feelings of helplessness and frequency of rumination on and magnification of pain. |
| Patient satisfaction | Post-op day 3, 8, and 15 | This will be measured on a Likert scale, as used in most orthopedics research. |
| Adverse reactions to pain medication | Post-op day 3, 8, 15 | Side effects of opioid and non-opioid medications will be assessed |
| Prescriptions filled and refilled | Post-op day 3, 8, 15 | We will assess whether patients both initially filled and re-filled their opioid prescriptions |
| Alternative analgesia used | Post-op day 3, 8, 15 | We will identify if patients use any alternative pain management strategies (i.e., elevation, icing, breathing exercises, mediation, etc.) |
| Mindfulness Attention Awareness Scale Score | Measured pre-operatively | This validated scale assesses dispositional mindfulness and has been shown to tap a unique quality of consciousness that is associated with self-regulation and well-being constructs. |
Countries
United States
Outcome results
None listed