Opioid Use Following Open Versus Endoscopic Carpal Tunnel Release: A Population Study

Background: Open (OCTR) and endoscopic carpal tunnel release (ECTR) are both effective treatments for carpal tunnel syndrome, with similar outcomes and complication rates. Given the opioid epidemic, it is important to consider how surgical modality impacts narcotic use. We compared narcotic use after OCTR and ECTR to identify trends and risk factors for prolonged postoperative use.Methods: We utilized the PearlDiver database to identify patients who underwent OCTR and ECTR between 2008 and 2015. Patients with opioid use were analyzed for trends. Early refills, prolonged postoperative opioid use, and new persistent opioid use were defined by time periods relating to the date of surgery. Age, gender, Charlson comorbidity index (CCI), and surgery type (open versus endoscopic) were analyzed as predictors for opioid use.Results: A total of 29,583 patients were included: 4125 (14%) ECTR and 25,458 (86%) OCTR. Significantly more OCTR patients filled perioperative prescriptions (62% versus 60%), and the OCTR group filled higher quantities of perioperative opioids (411 OME versus 379 OME). Patients in the OCTR group were also significantly more likely to obtain early refills and to have prolonged postoperative use. There was no difference in the rate of new persistent use.Conclusions: Compared with ECTR, patients who underwent OCTR filled higher quantities of opioids in the perioperative period, were more likely to obtain early refills, and were more likely to have prolonged postoperative use. These findings suggest either a lower opioid requirement after ECTR or a lower perceived requirement reflected in the difference in prescribing habits between techniques.