Carpal Tunnel Release Postoperative Pain Management: A Systematic Review of Randomized Controlled Trials

Abstract

Purpose

The management of postoperative pain after carpal tunnel release (CTR) has evolved over the years. This article reviews various approaches to pain management in the literature.

Methods

An electronic search was conducted using PubMed, Google Scholar, and SCOPUS for studies on CTR pain management using either preoperative, perioperative, or postoperative tools. Only randomized controlled trials were included in the narrative review. Articles included in the study evaluated patients diagnosed with carpal tunnel syndrome, underwent CTR, and had preoperative, perioperative, or postoperative intervention evaluated as a primary end point. Duration and quantity of opioids, and patient-reported pain scales, such as the visual analog scale, were calculated and compared.

Results

During the study period between 2015 and 2022, 10 randomized controlled trials met the inclusion criteria. Of these, studies were analyzed as either preoperative, perioperative, or postoperative means of managing pain. When these techniques were compared with opioid usage, no notable differences were found in pain ratings between patients who were given opioids for pain management compared with those provided with these nonopioid pain management options.

Conclusions

This review highlights the effectiveness of various preoperative, perioperative, and postoperative interventions for pain management after CTR. Although opioids are the current standard for pain management after CTR, our study highlights interventions that are as effective, if not more so, as opioids at lowering pain scores with this procedure.

Clinical relevance

The success of the studied alternatives in reducing pain outcomes for CTR can help mitigate the number of opioids prescribed to patients for the procedure. Given the current opioid epidemic plaguing the nation, understanding the efficacy of all other nonaddictive alternatives for pain management with CTR is imperative.