STRONG RECOMMENDATION One high-quality article (Husby 2001) showed no significant differences in observed outcomes for patients who underwent surgery for CTS treated with acetaminophen vs. patients that were given matching placebo pills. Three high-quality articles (Husby 2001 and Ilyas, 2018/2019) showed no significant differences in observed outcomes for patients who underwent surgery for CTS treated with acetaminophen vs. those who were given non-steroidal anti-inflammatory drugs (NSAIDs) (Naproxen or ibuprofen). Ilyas (2018) also showed that the patients who took acetaminophen or ibuprofen after mini-open carpal tunnel repair had statistically significantly lower Worst Daily Pain (0-10 scale) than those who took Oxycodone – 2.5 and 3.4 respectively. Ilyas (2019) again showed that the patients who underwent CTS surgery who took acetaminophen or ibuprofen also had less VAS Worst Daily Pain than patients who took Oxycodone – 2.5, 2.5, and 2.9 respectively; these differences reached statistical significance. Adverse events were also significantly less common in patients taking NSAIDs or acetaminophen in comparison to Oxycodone. Ilyas 2018 reported 11% of the oxycodone group reported adverse events compared to 3% in the acetaminophen group; Ilyas 2019 adverse events were reported in 15% of the oxycodone group, 1.6% of the acetaminophen group, and 1.6% in the NSAID group.
Benefits/Harms of Implementation
The benefit of having two non-opioid medications for postoperative pain management is that pain can still be managed despite concomitant conditions, which may preclude a patient from taking either NSAID or acetaminophen. In addition, this helps avoid the many adverse effects of opioids (overdose and addiction).
Outcome Importance
NSAIDs and acetaminophen are options to help control postoperative pain.
Acceptability
Accepted treatment for pain in the postoperative state as there are over-the-counter medications.
Feasibility
Feasible as these are over-the-counter medications that are familiar to patients and clinicians.
- Husby, T., Haugstvedt, J. R., Fyllingen, G., Skoglund, L. A.. (2001). Acute postoperative swelling after hand surgery: an exploratory, double-blind, randomised study with paracetamol, naproxen, and placebo. Scandinavian Journal of Plastic & Reconstructive Surgery & Hand Surgery, 35(1), 91-8.
- Ilyas, A. M., Miller, A. J., Graham, J. G., Matzon, J. L.. (2018). Pain Management After Carpal Tunnel Release Surgery: A Prospective Randomized Double-Blinded Trial Comparing Acetaminophen, Ibuprofen, and Oxycodone. Journal of Hand Surgery - American Volume, 43(10), 913-919.
- Ilyas, A. M., Miller, A. J., Graham, J. G., Matzon, J. L.. (2019). A Prospective, Randomized, Double-Blinded Trial Comparing Acetaminophen, Ibuprofen, and Oxycodone for Pain Management After Hand Surgery. Orthopedics, 42(2), 110-115.