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

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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