An integrated educational and multimodal approach to achieving an opioid-free postoperative course after arthroscopic rotator cuff repair

Abstract

Background In the realm of shoulder surgery, arthroscopic rotator cuff repair (RCR) is one of the most painful procedures and is often associated with higher opioid consumption. The purpose of this study was to evaluate effectiveness of preoperative and postoperative patient education and multimodal pain management to achieve an opioid-free postoperative recovery after RCR. Methods Sixty patients who underwent RCR were divided in 2 groups. All patientsreceived an interscalene nerve block and multimodal pain management. The opioid intervention group (OIG) in addition received preoperative education on expectations of pain, non opioid pain protocols, and alternate therapiesto minimize pain as well as customized postoperative instructions. Patients were compared on pain levels, opioid consumption, and outcomes scores preoperatively and at 48 hours, 2 weeks, and final follow-up. Patient-reported outcomes and opioid usage were compared and analyzed using student’s t-tests and logistic regression. Results At 48 hours, 15% of OIG patients reported use of rescue opioids after surgery compared with 100% of control group patients. Zero percent of OIG patients reported opioid use at 2 weeks compared to 90% of control group patients ( P = .0196). Patients in both groups showed significant improvements in all outcome scores ( P ≤ .05). At 6 weeks, functional, Constant, and satisfaction outcome scores were all higher in the OIG ( P < .05). At last follow-up, there were no significant differences for all patient-reported outcomes between groups. Conclusions Application of patient education tools and innovative multimodal pain management protocols successfully eliminates the need for opioids while maintaining excellent patient satisfaction and outcomes.

Application of risk assessment tools to predict opioid usage after shoulder surgery

“…In addition, the study showed that among patients undergoing shoulder arthroplasty 100% of those who received preoperative, intraoperative, and postoperative patient education in addition to multimodal pain management were opioid free by 2 weeks. 54 , 62 Brown-Taylor et al reported that 8 studies concluded a relationship between early PT and reduced subsequent opioid use in orthopedic procedures. 3 , 9 , 55 Therefore, these variables may be valuable areas to examine in future studies.…”

“… 6 , 16 , 30 , 38 , 48 , 60 Most orthopedic surgeons agree that overprescription is a problem, and significant efforts have been made to reduce opioid prescribing practices including the investigation and development of multimodal pain-management protocols and patient education tools. 23 , 31 , 35 , 44 , 53 , 54 However, the use of narcotics for postoperative pain control still remains frequent, particularly following shoulder surgeries. 30 , 60 , 67 Given the persistent challenge of the opioid crisis and the rapidly increasing utilization of shoulder surgery, there is a growing need for tools to identify patients at risk of chronic use, abuse, and dependence.…”

The Opioid Epidemic in America: Pandemic Impacts

“…42 Several pain protocols are now available for nearly every orthopaedic subspecialty. [43][44][45][46][47] The most common components include NSAIDs, non-narcotic analgesics, local and regional anesthetics, cold therapy, and stress relievers. Opioids are often included for the first few days, with a transitional emphasis to nonopioids to prevent long-term use.…”