Interventional sleep pathway may be safe, beneficial after total shoulder arthroplasty
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Results show use of an interventional sleep pathway may be safe and beneficial for patients undergoing shoulder arthroplasty and provide improved analgesia, reduced opioid usage, increased sleep duration and improved reported sleep quality.
“Shoulder arthroplasty patients in the postoperative phase have significantly disrupted sleep that can be treated to improve both sleep and pain control with short-term treatments that include both pharmacological and non-pharmacological interventions,” Jonathan W. Cheah, MD, told Healio.
Cheah and colleagues randomly assigned 125 patients undergoing anatomic and reverse total shoulder arthroplasty to either be enrolled in an interventional multimodal sleep pathway (intervention group; n=61) or not (control group; n=64). Researchers noted the multimodal sleep pathway included nursing-directed non-pharmacological measures that promote sleep hygiene, as well as pharmacological interventions with low-dose zolpidem and melatonin at bedtime. Researchers also provided all patients with a standardized multimodal analgesia protocol with scheduled acetaminophen, naproxen, gabapentin and a single-shot interscalene regional nerve block.
Results showed patients in the intervention group had less oral morphine milligram equivalents on postoperative day 0 and trended toward lower VAS pain scores on postoperative day 0. By postoperative day 1, researchers found the two groups had similar VAS pain scores and morphine milligram equivalent consumption. Quantitative wrist actigraphy showed patients in the intervention group had longer objective sleep duration with better sleep quality as assessed by the Leeds Sleep Questionnaire, according to results. Researchers noted similar satisfaction in pain and sleep management between both groups, as well as no difference in the length of inpatient stay.
“These results are promising to encourage further research and interventions for orthopedic patients as there is a significant interplay between sleep, pain and recovery after surgery,” Cheah said.
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