Multimodal Nonopioid Pain Protocol Provides Equivalent Pain Control Versus Opioids Following Arthroscopic Shoulder Labral Surgery: A Prospective Randomized Control Trial

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Journal of shoulder and elbow surgery


PURPOSE: To compare postoperative pain and patient satisfaction in patients undergoing primary arthroscopic labral surgery managed with either a nonopioid alternative pain regimen or a traditional opioid pain regimen.

METHODS: Sixty consecutive patients undergoing primary arthroscopic shoulder labral surgery were assessed for participation. In accordance with the Consolidated Standards of Reporting Trials 2010 (CONSORT) statement, a prospective randomized control trial was performed. The two arms of the study were a multimodal non-opioid analgesic protocol as the experimental group and a standard opioid regimen as the control group. The primary outcome was postoperative pain scores (visual analog scale) for the first 10 days postoperatively. Secondary outcomes included patient satisfaction, patient reported outcomes, and complications. Randomization was performed with a random number generator, and all data was collected by blinded observers. Patients were not blinded.

RESULTS: Twelve patients did not meet inclusion criteria or declined to participate. Forty-eight patients were included in the final analysis. Twenty-four patients were in the nonopioid group and twenty-four in the opioid group. There was no significant difference in VAS or PROMIS scores between patients in each cohort at any postoperative day (p>0.05). When controlling for confounding factors with mixed measured models, the non-opioid cohort reported significantly lower VAS and PROMIS-PI scores (p< 0.01) at all time points. No difference was found in reported adverse events (constipation, diarrhea, drowsiness, nausea, and upset stomach) between cohorts at any time point (p> 0.05).

CONCLUSION: The present study found that a multimodal nonopioid pain regimen provided at least equivalent pain control, adverse reaction profile, and patient satisfaction when compared to a standard opioid based regimen following arthroscopic shoulder labrum surgery.

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ePub ahead of print