Opioid-Free Arthroscopic Rotator Cuff Repair

Abstract

Rotator cuff repair is known to cause significant pain, and therefore opioids are often prescribed postoperatively. The United States is currently experiencing an opioid epidemic, and prescription opioids are considered a gateway drug to opioid abuse and addiction. Orthopedic surgeons are looking for alternative means to control pain. The purpose of this study was to evaluate the efficacy of an opioid-free postoperative pain protocol in patients following an arthroscopic rotator cuff repair. A prospective study of 36 consecutive patients was performed. Patient demographics, prior narcotic consumption, past medical history, and visual analog scale (VAS) pain score were collected. All patients received an opioid-free postoperative pain protocol, including education, premedication, interscalene nerve blockade, and intraoperative injection, and were discharged with ketorolac, zolpidem, and acetaminophen. A sealed envelope containing an oxycodone prescription was also received at discharge. Patients were instructed only to fill the oxycodone prescription if they had uncontrolled pain. The primary outcomes were filling of the oxycodone prescription and use. Secondary outcomes were VAS pain scores and patient satisfaction scores. Sixty-seven percent of patients successfully completed opioid-free arthroscopic rotator cuff repair. Patients who did not use oxycodone had lower pain scores overall when comparing each postoperative day. By the first postoperative visit, patients who did not take oxycodone also demonstrated higher satisfaction with their pain management. This study demonstrates that with appropriate multimodal pain management, the majority of willing patients can undergo rotator cuff repair without use of opioids. [ Orthopedics . 2021;44(2):e301–e305.]

Cannabidiol for Postoperative Pain Control After Arthroscopic Rotator Cuff Repair Demonstrates No Deficits in Patient-Reported Outcomes Versus Placebo: 1-Year Follow-up of a Randomized Controlled Trial

“…One prospective studies found that 67% of patients were able to complete opioid-free ARCR when undergoing multimodal pain regimen, including premedication, interscalene nerve block, intraoperative injection, and ketorolac, zolpidem, and acetaminophen at discharge. 40 A randomized controlled trial found that whereas a nonopioid group had significantly greater VAS pain on postoperative days 1 and 4 after ARCR, the nonopioid group actually demonstrated significantly lower VAS pain and pain intensity at every time point (P \ .01) when accounting for confounding factors. 17 Moutzouros et al 26 found that 45% of patients were able to complete nonopioid postoperative protocols when enrolling patients undergoing a wide range of sports orthopaedics procedures, including anterior cruciate ligament reconstruction, ARCR, labral repair, and meniscectomy.…”

“…20 Several prospective studies have investigated the feasibility of opioid-free postoperative protocols after ARCR as well as for other common sports orthopaedic procedures. 17,26,40 The Cannabis sativa plant is a promising alternative for augmented pain control, with its derivative cannabinoids, namely cannabidiol (CBD), the subject of increased investigation. While there is growing evidence from in vitro and animal studies for CBD as a pain modulator, 2,9,14,16,25,44,48 there remains a lack of high-quality evidence in orthopaedics with respect to CBD.…”

“… 20 Several prospective studies have investigated the feasibility of opioid-free postoperative protocols after ARCR as well as for other common sports orthopaedic procedures. 17 , 26 , 40 …”

Opioid-free anesthesia: the next frontier in surgical patient safety

“…The concept of dexmedetomidine-based anesthesia leverages the benefits of the multimodal pain control strategy in the perioperative arena to decrease both peripheral and central sensitization [ 11 ]. Notably, this new modality of general anesthesia has been shown to significantly reduce opioid consumption in patients undergoing bariatric surgery [ 12 ], pancreatic surgery [ 13 ], major urological procedures [ 14 ], rotator cuff repair [ 15 ], and total hip replacement [ 16 ]. A recent randomized controlled trial in gynecological surgery furthermore corroborated that opioid-free anesthesia was associated with significant improvement in postoperative analgesia, compared to traditional opioid-based anesthesia [ 17 ].…”