Management of postoperative pain following carpal tunnel release using opioids vs non-opioids: A comprehensive systematic review of the literature

Background: There is a lack of clear guidelines on best practices for managing pain after carpal tunnel release (CTR) using opioids and non-opioids. Purpose: The purpose of this review is to present the available evidence specific to the use of opioids and non-opioids to manage pain following CTR. Study Design: Systematic review. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for searching MEDLINE, Cochrane Central Register of Controlled Trials, Excerpta Medica Database, and Web of Science databases for English language using the keywords carpal tunnel, wrist surgery, and postoperative pain. Randomized controlled trials and cohort studies that compared the pharmacological use of oral opioids and non-opioids and patient-reported pain outcomes were included. Results: Initially, 2861 articles were identified. After applying predefined inclusion and exclusion criteria and conducting full-text screening, five randomized controlled trials totaling 691 patients were included. A comparative synthesis of these trials revealed that reported pain scores and mean pill consumption did not differ significantly between patients prescribed opioids vs non-opioids. Conclusions: Based on this limited review of five studies, the use of non-opioids, such as acetaminophen or ibuprofen, is not inferior to opioids for management of pain following CTR. Most authors recommend a multimodal analgesic approach combining acetaminophen and ibuprofen.