As has become apparent in the media, as well as in the clinical practice of nearly every type
of medicine over the last few years, the nation is currently experiencing an opioid epidemic.
This is a significant public health issue that has sweeping consequences that reach far
beyond the medical field. The investigators believe over the last several decades, public
perception regarding pain, especially post-operatively, has changed for the worse. The nation
is in need of a paradigm shift in the way pain is managed, and the way the public perceives
this issue, especially regarding pain expectations. As patients have become more involved
with medical care as well as more knowledgeable, the investigators often see patients having
performed online research regarding outcomes and expectations following particular
procedures, to include post-operative pain. Commonly, even for smaller procedures performed
in office, patients request opioids. As of yet, there are few data regarding use of long
acting (Exparel) local analgesia alone in hand surgery, and none combining this strategy with
pre-operative opioid education. The goal is to build the groundwork for the cessation of
opioid prescription following carpal tunnel surgery, and produce proof that may be given
patients to showing this to be an effective strategy. As some sources estimate 400,000 carpal
tunnel surgeries are performed yearly, it is believed that this alternative pain management
strategy, if adopted at a national level, would make a significant step towards remedying the
current crisis. The rationale as to why this will be successful is the duration of action of
Exparel, which has been shown to be effective for up to 72 hours. By 72 hours, post-procedure
pain levels tend to have dropped precipitously, if not resolved. Use of pre-operative opioid
education has also been shown to decrease perception of the need for and use of opioids. The
investigators plan to study two groups: a control/standard of care group, that are given
pre-operative opioid education as well as opioids, and a study group, which will have
pre-operative opioid education, Exparel injection, and no opioids. Exparel will be
administered as 10cc injected in the operative field, consisting of ~5cc of Exparel, ~5cc of
bupivacaine, and epinephrine. All injections will be performed in the same manner. Following
injection, carpal tunnel release will be performed in a similar manner in all patients.
Patients that meet all of the inclusion and none of the exclusion criteria would be eligible
for participation. If a patient agreed to participate, they would be randomized to group A
(standard of care + education), or group B (Exparel + education + no opioids). This would be
accomplished by drawing an A or B written on a paper ticket out of a bag. Adverse reactions
and pain levels at 24, 48, and 72 hours will be assessed with telephone or email
questionnaire, as will use of medication in the opioid group. Statistical analysis will be
performed using analysis of variance, Mann-Whitney U test, and/or chi square test, as
appropriate. The public health relevance of this project is to alter patient's perceived need
for opioid medications post procedure, and decrease the amount of circulating opioids locally
and nationally. The investigators believe this a meritorious goal, given that opioid related
overdose deaths have increased eight-fold from 2012 to 2016.