A Non-Opioid Multimodal Pain Protocol Achieves Equivalent Pain Control After Total Shoulder Arthroplasty: A Randomized-Controlled Trial

Document Type

Conference Proceeding

Publication Date

10-21-2024

Publication Title

JSES International

Abstract

Aim: The aim of this study was to evaluate the efficacy of a postoperative non-opioid multimodal pain protocol compared to an opioid protocol in terms of patient opioid utilization, postoperative pain control, and adverse effects for patients who underwent shoulder arthroplasty. Background: Orthopaedic surgeons are among the highest prescribers of opioid medications. Significant effort has been made to curtail the number of opioids prescribed through improved awareness of opioid stewardship and the development of multimodal pain management protocols. However, there remains a paucity of prospective data demonstrating the efficacy of a non-opioid protocol after total shoulder arthroplasty. Methods: We performed a prospective, randomized controlled trial including patients undergoing anatomic or reverse total shoulder arthroplasty. Patients were excluded if they underwent revision surgery, fracture, or received opioids within 3 months of surgery. All patients received standardized preoperative analgesic medications, general anesthesia, and an intraoperative periarticular injection without a regional block. Patients were randomly assigned to a postoperative non-opioid multimodal pain protocol or an opioid protocol containing 28 tablets of 5mg oxycodone in addition to the multimodal regimen. Patients completed visual analog scale (VAS) pain and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) surveys, and were queried for opioid usage and recorded adverse effects of medications for 10 days postoperatively. An intention-to-treat analysis was performed. Results: A total of 74 patients were enrolled and included in the analysis with 37 in each cohort. There were no significant differences in VAS pain (2.1 ± 1.9 multimodal vs. 2.5 ± 1.8 opioid; P > 0.05) or PROMIS-PI scores (60.4 ± 7.7 multimodal vs. 60.4 opioid ± 6.7; P > 0.05) between treatment groups at 10-days postoperatively. The morphine milligram equivalents (MME) consumed between discharge and 10 days postoperatively for the opioid group was 32.9 ± 49.1 compared to 2.4 ± 6.9 for the non-opioid group (P < 0.001). The most common medication side effects for both groups were constipation (52.9% [18/34] multimodal vs. 72.2% [26/36] opioid) and drowsiness although there were no significant differences in the duration of side effects or the number of days without any side effects (P > 0.05) between treatment groups. Age, sex, race, and body mass index were all similar between both treatment groups. Conclusion: A non-opioid multimodal pain protocol is safe and achieves similar pain control with significantly reduced MMEs consumed after shoulder arthroplasty.

Volume

8

Issue

6

First Page

1369

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