Ibuprofen led to less opioid use after arthroscopic rotator cuff repair
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Patients who received ibuprofen required less opiate medication 1 week after arthroscopic rotator cuff repair, but had similar pain scores at 6 weeks compared with patients who received placebo, according to a recent study.
Jennifer Tangtiphaiboontana, MD, and colleagues randomly assigned 110 patients undergoing primary arthroscopic rotator cuff repair to receive ibuprofen or placebo for 2 weeks after surgery in addition to the standard opioid medication.
“Patients were instructed to keep a pain diary for the first week and to bring in their medication bottle for pill counting,” Tangtiphaiboontana said in her presentation at the American Shoulder and Elbow Surgeons Annual Meeting.
Researchers collected pre- and postoperative clinical outcomes and performed ultrasound examination at 1 year to evaluate repair integrity.
The ibuprofen group comprised 51 patients and the placebo group included 50 patients after nine patients either withdrew or were dropped due to protocol non-compliance, according to Tangtiphaiboontana. Investigators observed no differences in VAS pain scores between the two groups at 6 weeks postoperatively.
“At 6 months, the ibuprofen group had higher ASES scores and forward flexion when compared to the placebo group,” Tangtiphaiboontana said. “However, there was no difference at 1 year.”
In the first postoperative week, Tangtiphiaboontana reported the ibuprofen group consumed 43 morphine mg equivalents less vs. the placebo group. Patients in the ibuprofen group also had less pain on postoperative days 3, 4, 5 and 6, she added.
“There were 74 patients available for ultrasound examination at 1 year,” Tangtiphaiboontana said. “Seven tears were seen on ultrasound in the ibuprofen group compared to 12 in the placebo group; however, this difference was not statistically significant.”
Editor’s note: On Jan. 8, 2021, we corrected the headline and lede of this article to clarify that ibuprofen led to less opioid use 1 week after arthroscopic rotator cuff repair but had similar pain scores at 6 weeks compared with placebo. The Editors regret this error.
Perspective
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For many patients, recovery from rotator cuff surgery can be painful. Unfortunately, strong medicines like narcotics often come with equally strong side effects.
Fueled by the desire to achieve safe, reliable pain control for their patients and to help quell the ongoing opioid crisis, surgeons have increasingly moved toward implementing multimodal approaches to pain management in the postoperative period. Use of educational aids, nerve blockade and oral medicines that address pain from alternative pathways are examples.
This study lends further support to using such an approach.
In a randomized controlled trial, these authors show that ibuprofen used in conjunction with postoperative narcotics can significantly reduce the amount of narcotic necessary to achieve equivalent pain relief in the postoperative setting. This study adds to the growing body of literature that taking a bigger picture view of pain control in the post-surgical setting can help curb surgeons’ prescribing “dependency” on narcotics.
In light of these and other recent findings, it may be a good time to re-evaluate our own prescribing habits to incorporate more opioid-sparing strategies in the postoperative setting of rotator cuff surgery.
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