Non-opioid protocol following TSA may result in ‘fourfold reduction’ in opioid consumption
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TAMPA, Fla. — Results showed an opioid-sparing postoperative pain management protocol after total shoulder arthroplasty resulted in a “nearly fourfold reduction” in pill consumption, earlier cessation of opioids and increased satisfaction.
“Orthopedic surgeons account for 80% of all dispensed opioid prescriptions. We sought better ways to reduce pain, but clearly there is no consensus on ideal management following shoulder arthroplasty,” Tyler J. Brolin, MD, an orthopedic shoulder surgeon from the Campbell Clinic at the University of Tennessee, said in his presentation at the American Shoulder and Elbow Surgeons Annual Meeting.
In their prospective, randomized control trial, Brolin and colleagues analyzed data for 78 patients who were randomized to either an opioid-sparing (OS) or a traditional opioid-based (OB) postoperative pain protocol. According to the abstract, both cohorts received opioid education, a periarticular injection with liposomal bupivacaine, acetaminophen, celecoxib and gabapentin. Additionally, the OS group received ketorolac, continuous cryotherapy and 10 oxycodone tablets for rescue only, while the OB group received 40 oxycodone tablets and performed standard icing.
Outcomes included VAS pain scores, which were assessed at multiple intervals up to 12 weeks after surgery, patient satisfaction, range of motion (ROM), American Shoulder and Elbow Surgeons Score (ASES), single assessment numeric evaluation (SANE) score, complications, readmissions and reoperations.
Overall, the OS group consumed less oral morphine equivalents (OME) at all time intervals compared with the OB group with no differences in ASES or SANE scores, complications, readmissions or reoperations. Total OME consumption was 112 in the OS group compared with 239 in the OB group. Brolin also noted 58.5% of patients in the OS group were off opioids at 2 weeks after surgery compared with 86.1% in the OB group. The OS group also reported higher satisfaction scores at 1 week and 6 weeks after surgery.
“Given the heightened awareness of opioid prescribing patterns, our regimen focused on patient education, cryotherapy, as well as a multimodal approach,” Brolin said. “Hopefully, this study can be used to guide future prescribing patterns after shoulder arthroplasty,” he added.
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Brolin TJ, et al. Paper 20. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Dec. 15-17, 2021; Tampa, Fla.
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