Opioid-free shoulder arthroplasty is safe, effective, and predictable compared with a traditional perioperative opiate regimen: a randomized controlled trial of a new clinical care pathway

Jolissaint, Josef E.; Scarola, Gregory T.; Odum, Susan M.; Leas, Daniel; Hamid, Nady; Chapman, Todd M.; Connor, Patrick M.; Curtin, Brian; Gaston, R. Glenn; Irwin, Todd A.; Loeffler, Bryan J.; Michalek, Caleb; Milam, R. Alden; Saltzman, Bryan M.; Schiffern, Shadley C.; Wally, Meghan K.

doi:10.1016/j.jse.2021.12.015

Cited by 12 publications

(13 citation statements)

References 36 publications

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“…11,29 Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and gabapentinoids have a wellestablished track record of alleviating musculoskeletal pain and/or reducing opioid consumption, gastrointestinal side effects, nausea, vomiting, and length of stay when used in the perioperative period in orthopedic patients. 11,28,30,31 Accordingly, these medications served as the cornerstone of analgesia in all phases of care assessed in this study. Previous studies on NSAIDs have demonstrated possible deleterious effects on osteogenesis and a possible association with increased rates of pseudarthrosis following spinal fusion, leading to a reluctance by some providers to administer NSAIDs in the setting of arthrodesis procedures.…”

Section: Discussionmentioning

confidence: 99%

“…The sample size estimate for this noninferiority RCT was based on the primary outcome of NRS at 24 hours postoperative using the treatment effect from a prior study conducted at our private practice. 28 More specifically, we assumed a mean pain score of 3.2 for the OC group, a mean pain score of 2.5 for the OF group, and a pooled SD of 2.5. With an a priori alpha level of 0.5 and a minimum power of 80%, a target enrollment of 50 patients per group was calculated.…”

Section: Methodsmentioning

confidence: 99%

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Opioid-Free Analgesia is Safe and Effective in Anterior Cervical Spine Surgery

Segebarth,

Schallmo,

Odum

et al. 2024

Clinical Spine Surgery

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Study Design: Randomized controlled trial (RCT). Objective: Compare the efficacy of a multimodal, opioid-free (OF) pain management pathway with a traditional opioid-containing (OC) pathway in patients undergoing anterior cervical procedures. Summary of Background Data: Previous studies have compared opioid-based pain regimens to opioid-sparing regimens following cervical spine surgery, but have been limited by high rates of crossover, retrospective designs, reliance on indwelling pain catheters, opioid utilization for early postoperative analgesia, and/or a lack of patient-reported outcome measures. Methods: This is a RCT in which patients were allocated to either an OF or OC perioperative pain management protocol. Eligible study participants included adult (age up to 18 y) patients who underwent primary, 1-level or 2-level anterior cervical surgery [anterior cervical discectomy and fusion (ACDF), anterior cervical disc arthroplasty (ACDA), or hybrid (ACDF and ACDA at different levels)] for degenerative pathology. The primary outcome variable was subjective pain level at 24 hours postoperative. The final study cohort consisted of 50 patients (22 OF, 28 OC). Results: Patients in the OF group reported lower median postoperative pain levels at 6 hours (4 for OF vs. 7 for OC; P=0.041) and 24 hours (3 for OF vs. 5 for OC; P=0.032). At 2-week and 6-week follow-up, pain levels were similar between groups. Patients in the OF group reported greater comfort at 12 hours (9 for OF vs. 5 for OC; P=0.003) and 24 hours (9 for OF vs. 5 for OC; P=0.011) postoperatively. Notably, there were no significant differences in patients’ reported pain satisfaction, overall surgical satisfaction, or overall sense of physical and mental well-being. In addition, there were no significant differences in falls, delirium, or constipation postoperatively. Conclusions: A multimodal OF pain management pathway following anterior cervical surgery for degenerative disease results in statistically noninferior pain control and equivalent patient-reported outcome measures compared with a traditional OC pathway.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Opioid-Free Analgesia is Safe and Effective in Anterior Cervical Spine Surgery

Segebarth,

Schallmo,

Odum

et al. 2024

Clinical Spine Surgery

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“…No significant differences in the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES), or Single Assessment Numeric Evaluation (SANE) scores; range of motion; complications; readmissions; or reoperation were seen between the groups. Jolissaint et al 4 conducted a randomized controlled trial comparing a completely opioid-free pain management pathway with a traditional opioid-containing pathway. Both groups received a preoperative interscalene block.…”

Section: Perioperative Managementmentioning

confidence: 99%

What’s New in Shoulder and Elbow Surgery

Kim,

Hsu,

Ricchetti

2023

Journal of Bone and Joint Surgery

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“…Low-dose ketamine (20–50 mg) can replace routine administration of intravenous opioids during shoulder surgery [5,12 ▪ ], and may reduce postoperative pain and opioid usage. Routine use of perioperative acetaminophen and nonsteroidal anti-inflammatory drugs is recommended [24 ▪▪ ]. Dexamethasone reduces nausea, improves pain control, and decreases opioid use [17 ▪▪ ].…”

Section: Multimodal Analgesiamentioning

confidence: 99%

Clinical care pathways for ambulatory total shoulder arthroplasty

Dong

YaDeau

2022

Current Opinion in Anaesthesiology

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Purpose of reviewTotal shoulder arthroplasty (TSA) is growing in popularity and is increasingly done on an ambulatory basis. This review examines recent developments in anesthesia and analgesia for ambulatory shoulder surgery. Pathway components are discussed and a sample pathway is described. Recent FindingsAdoption of pathways for shoulder surgery improves patient experience by reducing pain, opioid use, and side effects while improving patient satisfaction. Long-acting nerve blockade using adjuvants like dexamethasone provide long-lasting analgesia without rebound pain. Peripheral nerve blockade provides better analgesia than peri-articular injection of local anesthetic. There are multiple approaches to nerve blockade for shoulder surgery to consider, including interscalene, superior trunk, supraclavicular, and anterior suprascapular nerve blocks. Multimodal analgesia should include acetaminophen and nonsteroidal anti-inflammatory drugs, but routine gabapentinoids should not be used.

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Opioid-free shoulder arthroplasty is safe, effective, and predictable compared with a traditional perioperative opiate regimen: a randomized controlled trial of a new clinical care pathway

Cited by 12 publications

References 36 publications

Opioid-Free Analgesia is Safe and Effective in Anterior Cervical Spine Surgery

Opioid-Free Analgesia is Safe and Effective in Anterior Cervical Spine Surgery

What’s New in Shoulder and Elbow Surgery

Clinical care pathways for ambulatory total shoulder arthroplasty

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