Opioid-Sparing Protocols in Hand Surgery: Successes and Opportunities

The opioid epidemic has been a defining crisis in American health care. Many attempts to address the epidemic have focused on issues around opioid prescribing. Legislation at the state and federal levels has been passed; however, the results from these policies have been mixed. Changes to prescription workflows alongside patient and provider education have also had some success. Within hand surgery in particular, recent progress has been made toward promoting opioid-sparing regimens for postoperative pain, including nonopioid and limited-opioid protocols. These regimens offer promise particularly in the setting of ambulatory surgeries, especially soft tissue procedures, and potentially in more invasive and complicated surgical settings. However, there are downsides and failures from these protocols that must be addressed, such as limited data on bony and complex soft tissue procedures, minimal diversity on published alternatives for limited regimens, and times when multimodal approaches are not adequate. Future work should focus on developing opioid-sparing protocols for more complex procedures as well as identifying patients at risk of requiring more comprehensive pain management approaches even for relatively minor procedures.