Opioid requirement after rotator cuff repair is low with a multimodal approach to pain

Mandava, Nikhil K.; Routman, Howard; Liddy, Nicole; Haidamous, Georges; Denard, Patrick J.

doi:10.1016/j.jse.2020.09.032

Cited by 14 publications

(14 citation statements)

References 37 publications

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“…As pinpointed by Haidamous et al. [ 62 ], the risk might be related to an association of lateralization and distalization due to onlay designs. The authors concluded that increased postoperative distalization is associated with an increased risk of scapular spine fracture following RSA.…”

Section: Discussionmentioning

confidence: 99%

Problems, complications, and reinterventions in 4893 onlay humeral lateralized reverse shoulder arthroplasties: a systematic review (part I—complications)

et al. 2021

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Background Several modifications to the original Grammont reverse shoulder arthroplasty (RSA) design have been proposed to prevent distinctive issues, such as both glenoid and humeral lateralization. The aim of this systematic review was to determine rates of problems, complications, reoperations, and revisions after onlay lateralized humeral stem RSA, hypothesizing that these are design related. Methods This systematic review was performed in accordance with the PRISMA statement guidelines. A literature search was conducted (01.01.2000–14.04.2020) using PubMed, Cochrane Reviews, Scopus, and Google Scholar employing several combinations of keywords: “reverse shoulder arthroplasty,” “reverse shoulder prosthesis,” “inverse shoulder arthroplasty,” “inverse shoulder prosthesis,” “problems,” “complications,” “results,” “outcomes,” “reoperation,” “revision.” Results Thirty-one studies with 4893 RSA met inclusion criteria. The 892 postoperative problems and 296 postoperative complications represented overall problem and complication rates of 22.7% and 7.5%, respectively. Forty-one reoperations and 63 revisions resulted, with an overall reoperation rate of 1.7% and overall revision rate of 2.6%. Conclusions Problem, complication, and reintervention rates proved acceptable when implanting a high humeral lateralization stem in RSA. The most frequent problem was scapular notching (12.6%), and the most common postoperative complication was scapular stress fracture (1.8%). An overall humeral complication rate of 1.9% was identified, whereas short stems reported no humeral fractures or stem loosening. Infections (1.3%) proved to be the most common reason for component revision, and instability had a complication rate of 0.8%. Level of evidence Systematic review IV

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Section: Discussionmentioning

confidence: 99%

Problems, complications, and reinterventions in 4893 onlay humeral lateralized reverse shoulder arthroplasties: a systematic review (part I—complications)

et al. 2021

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“…These results are also consistent with another study that showed 77% of patients took fewer than 15 opioid pills when paired with an interscalene nerve block and with non-opioid medications were implemented. 16 Recent studies have demonstrated that preoperative opioid use in arthroscopic RCR can lead to increased postoperative opioid requirements. 17 , 18 Further, patients who filled opioid prescriptions preoperatively were 7.45 times more likely to fill opioid prescriptions postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Satisfactory Pain Management With Minimal Opioid Use After Arthroscopic Rotator Cuff Repair

Garvey

Lowenstein

Piana

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To evaluate patient use of opioids following arthroscopic rotator cuff repair, including the number of days and number of pills when used in combination with non-opioid medications and to determine whether patients were satisfied with their pain management and if variables such as age, sex, body mass index, duration of symptoms, anticipation of postoperative pain, preoperative opioid consumption, size of the rotator cuff tear, or anxiety/depression affected pain management. Methods This was a prospective cohort study of 117 prospectively enrolled patients older than the age of 18 years undergoing primary arthroscopic rotator cuff repair. All patients completed preoperative and 2-week postoperative questionnaires to assess their pain and satisfaction with pain management. Univariate and multivariate analyses were performed to evaluate the association of patient characteristics with satisfaction of pain control and amount/duration of opioids postoperatively. Results Patients required a median of 18 opioid pain pills or 135 morphine milligram equivalents (interquartiles, 6-35 pills) postoperatively over 6.9 ± 5.1 days. In total, 65% of patients took opioid pain medications for 7 days or fewer. On postoperative day 2, patients reported a VAS pain score of 6.6 ± 2.8 and at the 2-week postoperative visit, mean visual analog scale pain score was 3.5 ± 2.5. Differences in age, sex, body mass index, duration of symptoms, anticipation of postoperative pain, preoperative 2-item Patient Health Questionnaire, 2-item Pain Self-Efficacy Questionnaire, current opioid use, and surgical characteristics had no effect on, or association with, satisfaction with pain management postoperatively. Conclusions Following arthroscopic rotator cuff repair, patients can achieve satisfactory pain control using a multimodal approach with a median of 18 opioid pills (range 6-35 pills) over 6.9 ± 5.1 days when used in combination with non-opioid pain medications. Overall, 74.4% of patients were satisfied with their postoperative pain management. Level of Evidence Level II; Prospective cohort study.

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“…The majority of studies in opioid consumption in the shoulder and elbow literature address opioid usage after shoulder procedures, primarily shoulder arthroplasty and rotator cuff repair. [16][17][18][19][20][21][22] One previous study examined risk factors for chronic opioid use after elbow arthroscopy. 23 In this study, Rojas et al using data from a national database found that preoperative opioid filling, fibromyalgia, and psychiatric illness were associated with an increased risk of prolonged postoperative opioid use after elbow arthroscopy, whereas patients <40 years of age and chronic obstructive pulmonary disease were associated with a decreased risk.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Patients Use Fewer Opioids Than Prescribed After Arthroscopic Release of Elbow Contracture: An Evidence-Based Opioid Prescribing Guideline to Reduce Excess

Rojas

Rotman

Shields

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To generate an evidence-based opioid-prescribing guideline by assessing the pattern of total opioid consumption and the factors that may predict opioid consumption following arthroscopic release of elbow contracture and to investigate whether the use of continuous passive motion (CPM), as compared to physical therapy (PT), was associated with a decrease in pain and opioid consumption after arthroscopic release of elbow contracture. Methods Data collected from a randomized controlled trial that compared continuous passive motion (CPM) ( n = 24) to physical therapy (PT) ( n = 27) following arthroscopic release of elbow contracture was analyzed for opioid use. Fifty-one participants recorded their daily opioid consumption in a postoperative diary for 90 days. Multivariate analysis was performed to identify factors associated with opioid use. Recommended quantities for postoperative prescription were generated using the 50th percentile for patients without and the 75th percentile for patients with factors associated with higher opioid use. Results The median total opioid prescription was 437.5-mg morphine milligram equivalents (MMEs) (58 pills of 5 mg oxycodone) and the median total opioid consumption was 75 MMEs (10 pills of 5-mg oxycodone). Twenty-two percent of patients took no opioid medication, 53% took ≤10 pills, 69% took ≤20 pills and 75% took ≤30 pills. Predictors of higher opioid use were preoperative opioid use, age <60 years and inflammatory arthritis. The total opioid consumption appeared similar between the CPM and the PT group. Seventy-five percent of patient’s home opioid requirements would be satisfied using the following guideline: Patients undergoing contracture release for osteoarthritis or post-traumatic contracture should be given a prescription for 10 pills of 5 mg oxycodone or its equivalent at discharge. Patients with inflammatory conditions or those taking preoperative opioids should be prescribed 30 pills of 5 mg oxycodone or its equivalent. Conclusion This study suggests that most patients undergoing arthroscopic release of elbow contracture use relatively few opioid pills after surgery. Use of an evidence-based guideline could decrease opioid prescriptions substantially, while still effectively treating patients’ pain.

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Opioid requirement after rotator cuff repair is low with a multimodal approach to pain

Cited by 14 publications

References 37 publications

Problems, complications, and reinterventions in 4893 onlay humeral lateralized reverse shoulder arthroplasties: a systematic review (part I—complications)

Problems, complications, and reinterventions in 4893 onlay humeral lateralized reverse shoulder arthroplasties: a systematic review (part I—complications)

Satisfactory Pain Management With Minimal Opioid Use After Arthroscopic Rotator Cuff Repair

Patients Use Fewer Opioids Than Prescribed After Arthroscopic Release of Elbow Contracture: An Evidence-Based Opioid Prescribing Guideline to Reduce Excess

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