Multimodal non-opioid protocol may reduce pain after arthroscopic rotator cuff repair
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Compared with traditional opioid analgesics, a multimodal non-opioid pain protocol provided equivalent or better postoperative pain control for patients who underwent primary arthroscopic rotator cuff repair, according to published results.
Toufic R. Jildeh, MD, and colleagues performed an observer-blinded, prospective randomized controlled trial, which analyzed 40 patients who underwent primary arthroscopic rotator cuff repair (RCR) with a 2-week follow-up. Researchers compared outcomes of 23 patients who were prescribed 40 pills of 5 mg oxycodone for postoperative pain and 17 patients who were prescribed a multimodal, non-opioid pain protocol, which consisted of ketorolac, gabapentin, methocarbamol and acetaminophen.
According to the study, outcome measures included VAS pain scores for the first 10 postoperative days, Patient-reported Outcomes Measurement Information System-pain interference (PROMIS-PI) scores, patient satisfaction and drug-related complications.
On postoperative day 1, the non-opioid group reported a mean VAS score of 3.7, while the opioid group reported a score of 5.7. Similarly, on postoperative day 4, the non-opioid group reported a mean VAS score of 2.4, while the opioid group reported a score of 4.4. No significant differences were seen in VAS scores on any other postoperative day, according to the study.
After using mixed measured modeling and controlling for confounding factors, Jildeh and colleagues found the non-opioid group demonstrated significantly lower VAS and PROMIS-PI scores at every postoperative time point. Patients in opioid group also reported more days with constipation and days with an upset stomach, researchers noted.
“In conjunction with national efforts to reduce opioid addiction and consumption, the results suggest a multimodal non-opioid pain protocol may be an effective alternative for postoperative pain management following arthroscopic RCR,” the researchers wrote in the study.
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