What is the recommended duration of oxycodone (opioid analgesic) therapy for a patient after left hand contracture surgery?

Duration of Oxycodone Therapy After Left Hand Contracture Surgery

For most patients undergoing left hand contracture surgery, oxycodone should be prescribed for no more than 5-7 days postoperatively, with most patients requiring fewer than 15 pills total. 1

Recommended Approach to Postoperative Pain Management

Initial Pain Management

• Immediate-release oxycodone should be used when simple analgesics (acetaminophen, NSAIDs) are insufficient to achieve functional pain relief 1
• Oral route should be used as soon as possible for medication administration 1
• Multimodal analgesia should be implemented with non-opioid medications as the foundation:
  • Acetaminophen (scheduled dosing) 1
  • NSAIDs (if not contraindicated) 1
  • Regional anesthesia techniques when appropriate 1

Oxycodone Prescribing Guidelines

• Prescribe no more than 5-7 days of immediate-release oxycodone 1
• For hand surgery specifically, 5-10 pills total is typically sufficient 2
• Dosing should be age-related rather than weight-based and consider renal function 1
• Modified-release oxycodone preparations should be avoided without specialist consultation 1

Monitoring and Tapering

• Sedation scores should be recorded alongside respiratory rate to detect risk of opioid-induced ventilatory impairment 1
• When analgesic requirements decrease, follow a reverse analgesic ladder:
  1. Wean opioids first
  2. Then stop NSAIDs
  3. Finally stop acetaminophen 1

Evidence Supporting Limited Opioid Duration

• Research shows that most hand surgery patients can achieve adequate pain control with non-opioid medications or minimal opioid use 2
• In a study of carpal tunnel release surgery, patients using oxycodone consumed an average of only 2.9-3.7 pills total over 5 days 2
• Even for more extensive shoulder surgeries like rotator cuff repair, 77% of patients required fewer than 15 oxycodone pills postoperatively 3

Discharge Planning and Follow-up

• Patients should receive clear instructions on:
  • How to safely self-administer opioids 1
  • How to properly wean analgesics 1
  • Safe disposal of unused medication 1
• The discharge letter must explicitly state the recommended opioid dose and planned duration 1
• Patients should be encouraged to keep a record of analgesics taken 1
• If a patient continues to require opioids beyond 90 days postoperatively, this should trigger further assessment for possible chronic post-surgical pain 1

Special Considerations

• For patients already on buprenorphine therapy, management is more complex and requires coordination with their buprenorphine provider 1
• For elderly patients (>70 years) or those with renal impairment, alternative opioids may be more appropriate than oxycodone 1
• Patients should be warned about the dangers of driving or operating machinery while taking opioid medications 1

By following these guidelines, most patients undergoing hand contracture surgery can achieve adequate pain control with minimal opioid use, reducing the risk of prolonged use or dependence.