Perioperative Pain Control in Upper Extremity Surgery: Prescribing Patterns, Recent Developments, and Opioid-Sparing Treatment Strategies.

BACKGROUND: Perioperative pain management in hand and upper extremity surgery has become increasingly challenging following recent efforts to accelerate postoperative recovery, decrease length of stay, and maximize the number and complexity of surgical interventions provided in an ambulatory setting. This issue has been further complicated by the growing opioid epidemic in the United States and increasing insights into its detrimental effects on society. Practicing hand surgeons must acknowledge this ongoing public health crisis and adapt their clinical practices to minimize and optimize distribution of prescription opioids.

METHODS/RESULTS: This review outlines current opioid prescribing patterns, recent developments, and treatment strategies designed to maintain effective perioperative analgesia in orthopedic upper extremity surgery while minimizing opioid delivery available for diversion, misuse, and abuse.

CONCLUSIONS: The authors advise hand surgeons to utilize the strategies discussed in this review to assist in forming a unique, patient-specific postoperative analgesic regimen.