Perioperative acetaminophen may decrease opioid use after rotator cuff repair
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Use of perioperative acetaminophen significantly decreased overall opioid consumption and improved pain control following arthroscopic rotator cuff repair, according to results.
“We feel that based on these results, [perioperative acetaminophen] is certainly an important component of multimodal analgesia for patients,” Jacob M. Kirsch, MD, said in his presentation at the American Shoulder and Elbow Surgeons Annual Meeting.
Kirsch and colleagues randomly assigned 57 patients undergoing arthroscopic full-thickness rotator cuff repair to receive oxycodone and acetaminophen as needed postoperatively (group 1), oxycodone only (group 2) or 1,000 mg of acetaminophen every 6 hours for 24 hours prior to and after surgery then every 8 hours as needed during postoperative days 2 through 5 (group 3).
“Additionally, patients in [group 3] could also take oxycodone every 6 hours as needed following surgery,” Kirsch said in his presentation.
Researchers assessed baseline demographics, total opioid use as measured by the number of 5-mg oxycodone pills, pain scores, side effects and overall patient satisfaction for the three groups.
Kirsch noted no significant differences in patient demographics, concomitant biceps procedures and the number of tendons repaired between any of the groups.
“Looking at the results that evaluated opioid consumption, pain and satisfaction, group 3, on average, took significantly fewer oxycodone pills and reported significantly better overall pain control compared to the other groups,” Kirsch said.
Patients in group 3 also took significantly fewer oxycodone pills each day compared with group 2, as well as significantly fewer oxycodone pills on the first postoperatively day compared with group 1, according to Kirsch.
“Additionally, when we compared group 1, which also had acetaminophen as part of its regimen, to the group with just oxycodone, which was group 2, we noticed the results are not as impressive when compared to the effect that group 3 had relative to group 2,” he said.
Perspective
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All efforts to reduce opioid consumption after rotator cuff surgery and move toward a multimodal approach in postoperative pain management should be applauded, especially given the current opioid crisis in the United States. As this group has shown in prior research, patient education and expectations for pain management are key postoperatively. The pain of rotator cuff surgery is a well-known stigma in the general population, with many patients coming into surgery having heard terrible stories of others’ postoperative pain. However, with proper encouragement and education, this study clearly supports patients can be satisfied with less narcotics postoperatively. If they believe it will be effective for them, it is highly likely that it will.
Outcomes such as in this study can help patients have confidence in a lower narcotic plan after surgery with the utilization of acetaminophen. As physicians, we should do all we can to minimize postoperative narcotic usage and continue with studies that explore other multimodal options. We should be optimistic that one day we can move toward a future of minimal to no postoperative narcotics at all.
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Singh AM, et al. Effect of preoperative and postoperative doses of acetaminophen on pain management in patients undergoing rotator cuff repair: A prospective randomized study. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 2-3, 2020 (virtual meeting).
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