PDF icon Download PDF
J Reconstr Microsurg
DOI: 10.1055/a-2576-0128
Original Article

The Efficacy of Upper Extremity Neuroma Surgery in Reducing Long-Term Opioid Use in Patients with Preoperative Opioid Use

Emmanuel O. Emovon III
1   Duke University School of Medicine, Durham, North Carolina
,
Hannah Langdell
2   Division of Plastic, Oral, and Maxillofacial Surgery, Duke University Medical Center; Durham, North Carolina
,
Elliott Rebello
3   Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
J. Alex Albright
3   Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Ethan Ong
1   Duke University School of Medicine, Durham, North Carolina
,
Daniel Y. Joh
2   Division of Plastic, Oral, and Maxillofacial Surgery, Duke University Medical Center; Durham, North Carolina
,
Suhail K. Mithani
2   Division of Plastic, Oral, and Maxillofacial Surgery, Duke University Medical Center; Durham, North Carolina
4   Division of Hand, Upper Extremity, and Microvascular Surgery, Department of Orthopedic Surgery, Duke University Medical Center; Durham, North Carolina
,
Neill Y. Li
4   Division of Hand, Upper Extremity, and Microvascular Surgery, Department of Orthopedic Surgery, Duke University Medical Center; Durham, North Carolina
› Author Affiliations
Funding None.
› Further Information
Also available atMedOne
   Permissions and Reprints
Preview

Abstract

Background

Neuromas can cause severe neuropathic pain, leading to functional decline and psychosocial distress. For pain relief, patients refractory to medications for neuropathic pain may be prescribed opioids; however, such use has been shown to have unfortunate adverse effects. With increasing awareness and diagnostic capabilities for neuroma formation, this study evaluates whether upper extremity neuroma excision may reduce opioid use and if adjunctive nerve procedures further reduce opioid use.

Methods

The PearlDiver database was queried for patients undergoing upper extremity neuroma excision surgery from 2010 to 2020. Patients with opioid prescription fill records preoperatively were extracted and stratified by an operative technique involving either (1) excision alone, (2) nerve implantation into bone or muscle, or (3) nerve reconstruction. Records were then assessed at 1, 3, and 6 months postoperatively to assess for opioid use. Prescription fill rates at 1, 3, and 6 months postoperatively were then assessed across techniques.

Results

Of the 14,330 patients that underwent upper extremity neuroma excision, 4,156 filled opioids preoperatively. Excision led to significant reductions in opioid prescription fill rates postoperatively, decreasing to 67.4% at 1 month and to 57.5% by 6 months (p < 0.001). Excision alone resulted in lower opioid use compared with excision with implantation at all postoperative time points (p < 0.05). At 6 months, opioid use was also significantly less following excision with nerve reconstruction compared with implantation (56.4% vs. 65.6%, p = 0.0096). There were no differences between excision alone and excision with nerve reconstruction.

Conclusion

Neuroma excision significantly reduces opioid use in patients with preoperative opioid use while adjunctive operative techniques did not potentiate opioid reduction. This highlights the importance of understanding patient complaints, neuroma localization, and candidacy for excision as an effective measure for addressing opioid use in patients with preoperative opioid dependence.

Keywords

neuroma - opioids - neuroma surgery - nerve surgery

Presentation at

This work was presented at the 2024 American Society for Surgery of the Hand and The Australian Hand Surgery Society.




Publication History

Received: 05 October 2024

Accepted: 02 April 2025

Accepted Manuscript online:
07 April 2025

Article published online:
02 May 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA