THE USE OF NON-OPIOID MULTIMODAL ANALGESIA FOR TOTAL SHOULDER ARTHROPLASTY: A RETROSPECTIVE STUDY

Document Type

Conference Proceeding

Publication Date

9-1-2023

Publication Title

JSES International

Keywords

celecoxib, dexamethasone, epinephrine, ibuprofen, ketorolac, magnesium, morphine, opiate, oxycodone plus paracetamol, paracetamol, pregabalin, ropivacaine, tizanidine, tramadol, adult, analgesia, analgesic activity, cohort analysis, complication, conference abstract, controlled study, drug dose reduction, drug therapy, female, hospital readmission, human, major clinical study, male, middle aged, outpatient department, people by smoking status, postoperative complication, postoperative pain, reoperation, retrospective study, shoulder, total shoulder arthroplasty, visual analog scale

Abstract

Background: The purpose of this study was to compare the pain level and the amount of opioid consumed in postoperative total shoulder arthroplasty (TSA) patients who were treated with a standard opioid-including regimen versus a non-opioid multimodal analgesia regimen. Methods: We retrospectively reviewed two consecutive cohorts who underwent TSA—either anatomic or reverse—by a single surgeon. The opioid cohort included patients from early 2016 to late 2020 and were given 80 tablets of Percocet 5 mg/325 mg that followed a dose reduction plan to 60, 40, and 20 tablets for consecutive refills (max of 3 refills). The non-opioid cohort included patients from late 2020 to mid 2022 and consisted of preoperative oral analgesics (Celecoxib, Pregabalin, and Tramadol); intraoperative IV Dexamethasone and Acetaminophen, and local infiltration of Ropivacaine, Epinephrine and Ketorolac; and postoperative oral Dexamethasone and oral analgesics (Pregabalin, Tizanidine, Magnesium, Ibuprofen, and Acetaminophen). Visual Analog Scale (VAS) scores for pain (preoperative, and 10-days, 6-weeks, 3-months, and 6-months postoperative) and opioid consumption (preoperative, and 10-days, 6-weeks, and 3-months postoperative) using Morphine Milligram Equivalents (MME) were compared and analyzed using the nonparametric Wilcoxon rank-sum test for both cohorts. Total MME was calculated as max consumption. Results: There were 249 patients in the opioid cohort and 127 in the non-opioid cohort. No between-group differences were found in demographic factors—including age, sex, race, BMI, smoking status—or anatomic versus reverse TSA. Patients treated with the non-opioid protocol had lower mean VAS scores at preoperative (6.4 vs 7.4, p<0.05), 10-day (3.5 vs 4.2, p<0.05), and 6-week postoperative time points (2.1 vs 2.8, p<0.05). Opioid consumption was lower in the non-opioid multimodal cohort at all time periods (p<0.005). Complications such as 90-day hospital readmissions and revision surgery at one-year were not significantly different between the groups. Conclusions: A non-opioid multimodal postoperative regime is reliable and well tolerated by patients undergoing Total Shoulder Arthroplasty. They have lower early postoperative VAS scores (10-days and 6-weeks) and a significant reduction in opioid utilization. One-year postoperative complications between both groups were similar indicating that a non-opioid regimen is effective in safely controlling postoperative pain.

Volume

7

Issue

5

First Page

2004

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