Cryo-pneumatic compression may reduce opioid use, improve function after shoulder surgery
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Key takeaways:
- A cryo-pneumatic compression device may decrease opioid consumption and improve function after shoulder surgery.
- Outcomes were compared with standard of care rehabilitation.
Use of a cryo-pneumatic compression device may decrease opioid consumption and improve function after shoulder surgery compared with standard of care rehabilitation, according to published results.
Moin Khan, MD, MSc, associate professor of orthopedic surgery at McMaster University in Ontario, Canada, and colleagues performed a randomized controlled trial of 200 patients who underwent unilateral shoulder surgery between December 2019 and February 2023.
Khan and colleagues randomly assigned 102 patients to use a cryo-pneumatic compression device (Game Ready ATX shoulder wrap, Avanos Medical Inc.) for postoperative rehabilitation and 98 patients to receive standard of care rehabilitation. According to the study, standard of care rehabilitation included rest, ice and compression using cryotherapy devices other than the cryo-pneumatic compression device.
Outcomes were collected at 2, 6 and 12 weeks postoperatively and included numeric rating scale pain scores, opioid consumption in morphine milligram equivalents (MMEs), SF-36 physical function scores and quality of life.
Overall, Khan and colleagues found patients who used the cryo-pneumatic compression device had decreased opioid consumption (median of 56.1 MMEs) compared with patients who received standard rehabilitation (median of 112 MMEs). In addition, they found patients who used the cryo-pneumatic compression device had significantly increased mean SF-36 physical function scores at 2 weeks compared with patients who received standard rehabilitation (61.2 vs. 54.2).
“The opioid use reductions demonstrated in this study suggest that cryo-pneumatic compression in conjunction with multimodal opioid-sparing protocols further reduces the reliance on narcotic medications,” Khan and colleagues wrote in the study.
Perspective
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This multicenter, randomized controlled trial assessed the effectiveness of a cryo-pneumatic compression device in reducing pain after shoulder surgery in 200 patients. One group received cryo-pneumatic compression therapy, while the control group used traditional methods, possibly including cryotherapy without pneumatic compression. The primary outcome was opioid use reduction, measured in oral morphine milligram equivalents (OMME), while secondary outcomes included patient-reported measures, such as the SF-36 and numeric rating scale (NRS) pain scores.
Results showed patients using the cryo-pneumatic compression device consumed significantly fewer opioids compared with the control group, and this was accompanied by an improvement in the SF-36 physical function score 2 weeks postoperatively (P < .05.) However, there was no significant difference in time to cessation of opioid use between the groups, nor were there significant differences in pain scores or other quality of life measures throughout the 12-week study period.
While this is a well-designed randomized controlled trial and the results suggest that cryo-pneumatic compression may reduce opioid use in the early postoperative period after shoulder surgery, the strength of this conclusion is limited by the lack of statistically significant improvements in pain scores during the duration of the trial.
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