A Prospective, Randomized, Double-Blinded Trial Comparing Acetaminophen, Ibuprofen, and Oxycodone for Pain Management After Hand Surgery

The goal of this study was to evaluate 3 common oral analgesics-oxycodone (OXY), ibuprofen (IBU), and acetaminophen (ACE)-for pain management following carpal tunnel release (CTR) and trigger finger release (TFR) surgery. Outcome measures were pain scores, capsule consumption patterns, and satisfaction. Carpal tunnel or trigger finger patients indicated to undergo primary, unilateral release received 10 capsules of either OXY (5 mg), IBU (600 mg), or ACE (500 mg) postoperatively. Medications were distributed in a randomized fashion, with both surgeons and patients blinded to the selected analgesic. Postoperatively, patients recorded pain level each day using a 0 to 10 visual analog scale, the number of capsules taken each day, and any adverse effects experienced. Medication distribution among the 188 patients completing the study was 62 OXY, 64 IBU, and 62 ACE. Surgical distribution was 76 TFR, 61 endoscopic CTR, and 51 open CTR. Overall, the mean total number of capsules consumed from postoperative days 0 through 5 for OXY, IBU, and ACE was 3.2, 4.0, and 3.1, respectively (P>.05). Mean worst daily pain score for the OXY, IBU, and ACE groups was 2.9, 2.5, and 2.5, respectively (P<.05). On subgroup analyses by procedure type, the only difference was found in the open CTR group, with the highest daily pain scores noted in the OXY group (P<.05). Nine of the 11 patients experiencing an adverse reaction also came from the OXY group. There were no reoperations or allergic reactions in any group. In this study, no clinically significant difference in pain experience or capsule consumption based on postoperative opioid vs nonopioid medication was identified. Adverse events were highest in the OXY group. In lieu of opioids, the authors suggest prescribing nonopioids first following TFR and CTR surgery. In addition, they advise prescribing 5 to 10 or fewer pills postoperatively regardless of the analgesic selected. [Orthopedics. 2019; 42(2):110-115.].