March 28, 2022
1 min read
Use of NSAIDs did not affect recurrent instability after arthroscopic Bankart repair
CHICAGO — Use of NSAIDs after arthroscopic Bankart repair for anterior shoulder instability did not affect recurrent instability, according to results presented at the American Academy of Orthopaedic Surgeons Annual Meeting.
Guillem Gonzalez-Lomas, MD, and colleagues randomly assigned patients undergoing arthroscopic Bankart repair from 2017 to 2019 to receive either 600 mg of ibuprofen with a few pills of 5 mg oxycodone and 325 mg acetaminophen for breakthrough pain or 5 mg oxycodone and 325 mg acetaminophen to be used every 6 hours as needed for pain relief. Researchers compared recurrent instability, revision surgery, VAS score, subjective shoulder value, satisfaction, whether patients would undergo the same surgery again, and rate, level and timing of return to play between the two groups.
Guillem Gonzalez-Lomas
With an 80% follow-up at 2 years, Gonzalez-Lomas noted they found no differences in patient demographics or clinical outcomes, including pain, subjective shoulder value, satisfaction, further instability events or surgery for instability, and whether patients would undergo the procedure again, between the two groups.
“We did a separate analysis on a group of elite athletes as part of our cohort,” Gonzalez-Lomas said in his presentation. “In this group, there was no difference as well at both return to play, return to play at previous level, pain with sport or time to return to play.”
Perspective
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Guillem Gonzalez-Lomas, MD, and colleagues have presented on whether NSAIDs will affect the healing of a Bankart shoulder repair. Anatomic repair for anterior shoulder dislocation is a common treatment often performed arthroscopically and, in select cases, as an open procedure. Pain management has gained attention as the opioid crisis has introduced other forms of analgesia, including the use of nonsteroidal anti-inflammatory medications as a substitute for oxycontin or similar medications. There have been some studies of delayed or incomplete healing with early postoperative use of NSAID treatment when performing rotator cuff surgery. Gonzales-Lomas has studied an instability recurrence in patients using NSAIDs in conjunction of oxycontin or oxycontin without NSAIDs. Their findings did not suggest a significantly different outcome when NSAIDs were used to assist early pain management.
Although I am encouraged by this presentation at AAOS, I remain concerned with their conclusions. Although numerical significance was not determined, this may be due to small sample size and short follow-up. The criticism of a soft tissue repair has been that this is a short period of study following return to activities and continued sports participation would increase failure rates with additional time.
As in other postoperative healing surgeries, early use of NSAIDs may produce a small effect on healing potential, but in this active population, reduced recurrence is at a premium. The reduction of opioid use is an important message promoted by this study. Techniques that reduce medication needs, as in icing, selective compression, massage and therapeutic modalities, should be considered as important postoperative details. The jury may still be out on the use of NSAIDs during the early postoperative period following shoulder stabilization surgery.
Jeffrey S. Abrams, MD
Clinical professor, Seton Hall University
Senior attending surgeon, Penn Med Princeton Medical Center
Princeton, New Jersey
Disclosures: Abrams reports no relevant financial disclosures.
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Source:
Fariyike BB, et al. Paper 689. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. March 22-26, 2022; Chicago.
Disclosures:
Gonzalez-Lomas reports no relevant financial disclosures.