Patient Education and Use of Post Operative Pain Medication in Ambulatory Hand Surgery: a Randomized Controlled Trial

Study Overview
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Brief Summary
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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.

Official Title
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Patient Education and Use of Postoperative Pain Medication in Ambulatory Hand Surgery: a Randomized Controlled Trial

Conditions
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Ambulatory Hand Surgery

Intervention / Treatment
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* Behavioral: Patient education regarding indications for opioid use and side effects of opioid use after hand surgery
* Other: Standard of care post-operative counseling


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Patient education group<br> | Behavioral: Patient education regarding indications for opioid use and side effects of opioid use after hand surgery<br>* 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.<br>|
| Active Comparator: Control- Standard of care counseling<br> | Other: Standard of care post-operative counseling<br>* Patients will receive standard of care post-operative counseling. They will not be given pre or post-operative opioid education.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of prescription opioids used postoperatively |  | Within 14 days of surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient satisfaction | This will be measured on a Likert scale, as used in most orthopedics research. | Post-op day 3, 8, and 15 | 
| Pain level | Numeric Rating Scale pain scores | Post-op day 3, 8, 15 | 
| Surgical factors | Type of surgery, length of surgery, type and amount of anesthesia | Recorded on day of surgery | 
| Pain Catastrophization Score | 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. | Measured pre-operatively | 
| Mindfulness Attention Awareness Scale Score | 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. | Measured pre-operatively | 
| Adverse reactions to pain medication | Side effects of opioid and non-opioid medications will be assessed | Post-op day 3, 8, 15 | 
| Prescriptions filled and refilled | We will assess whether patients both initially filled and re-filled their opioid prescriptions | Post-op day 3, 8, 15 | 
| Alternative analgesia used | We will identify if patients use any alternative pain management strategies (i.e., elevation, icing, breathing exercises, mediation, etc.) | Post-op day 3, 8, 15 |