Multimodal pain management may successfully replace opioids in arthroscopic rotator cuff repair
Click Here to Manage Email Alerts
Use of appropriate multimodal pain management may allow patients to undergo arthroscopic rotator cuff repair without the use of opioids, according to results.
Luke S. Austin, MD, and colleagues collected demographics, prior narcotic consumption, past medical history and VAS scores for 36 patients who underwent arthroscopic rotator cuff repair. Researchers provided patients with an opioid-free postoperative pain protocol which included education, premedication, interscalene nerve blockade, intraoperative injection and receipt of ketorolac, zolpidem and acetaminophen at discharge. Researchers also provided patients with a prescription of oxycodone at discharge with instructions to only fill the oxycodone prescription if they had uncontrolled pain. Researchers considered filling and use of the oxycodone prescription as the primary outcome measure, while VAS pain scores and patient satisfaction scores were considered the secondary outcome measures.
Austin noted successful completion of opioid-free arthroscopic rotator cuff repair among 67% of patients.
“Patients who did not use oxycodone demonstrated higher satisfaction with their pain management,” Austin, shoulder and elbow surgeon at Rothman Orthopaedic Institute, told Healio Orthopedics.
When comparing each postoperative day, researchers also found lower pain scores overall among patients who did not use oxycodone. Researchers found patients with hypertension consumed more oxycodone.
“We concluded that with appropriate multimodal pain management, the majority of willing patients can undergo rotator cuff repair without use of opioids,” Austin said. – by Casey Tingle
Reference:
Theosmy EG, et al. ePaper 592. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
Disclosure: Austin reports he receives IP royalties from Ignite Orthopedics; has stock or stock options in Ignite Orthopedics and preliminary patent filed for reference implant; receives other financial or material support from Rothman Institute and Related Holdings; and receives research support from Zimmer.
Perspective
Back to Top
Joaquin Sanchez-Sotelo, MD, PhD
Minimizing the amount of narcotic pain medication prescribed to patients after orthopedic surgery has become a major initiative across the United States. This initiative responds to the opioid overdose epidemic, identified as a national health care problem during the last few years. The authors of this study reported a 67% success rate when they attempted to use an opioid-free pain protocol after rotator cuff repair. On one hand, it is encouraging to confirm that many patients were able to cope with their pain level without opioids. On the other hand, the particular multimodal combination used in this study (interscalene nerve blockade, acetaminophen, ketorolac and zolpidem) was not enough for more than one-third of the patients.
A few questions come to mind: Was the interscalene nerve blockade performed prior to surgery in order to function as preemptive? Were liposomal formulations of local anesthetic used? Were narcotic-naïve patients more likely to cope with postoperative pain without resorting to narcotics? This study points to the right direction, and it also emphasizes the need for additional research to further improve narcotic-free pain management strategies after orthopedic shoulder surgery.
Mayo Clinic
Collapse
Theosmy EG, et al. ePaper 592. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
Read more about
Click Here to Manage Email Alerts