Postoperative pain associated with orthopedic shoulder and elbow surgery: a prospective study

Desai, Vimal; Cheung, Emilie V.

doi:10.1016/j.jse.2011.09.021

Cited by 17 publications

(20 citation statements)

References 79 publications

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“…[23] Although patients undergoing lower-extremity joint replacement represent a population with more severe pain and dysfunction, it is possible that similar pain phenotypes could be seen in a shoulder surgery population. As was seen in the present study, the fibromyalgia survey score was recently shown to be associated with a worse preoperative pain phenotype in lower-extremity joint replacement patients.…”

Section: Discussionmentioning

confidence: 99%

“…This led to the hypothesis that the fibromyalgia survey score may predict postoperative pain outcomes in other cohorts. Shoulder arthroscopic surgeries can potentially result in moderate-to-severe pain,[1, 23] although they are less invasive than lower-extremity joint replacement surgeries. On POD 2, the lowest tertile of fibromyalgia survey scores had significantly better physical function when compared to the other groups, as well as non-significant trends in lower opioid consumption, pain scores, and neuropathic pain.…”

Section: Discussionmentioning

confidence: 99%

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The Fibromyalgia Survey Score Correlates With Preoperative Pain Phenotypes But Does Not Predict Pain Outcomes After Shoulder Arthroscopy

Cheng

Kahn

YaDeau

et al. 2016

The Clinical Journal of Pain

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Objectives Fibromyalgia characteristics can be evaluated using a simple, self-reported measure, which correlates with postoperative opioid consumption following lower-extremity joint arthroplasty. The purpose of this study was to determine if preoperative pain history and/or the fibromyalgia survey score can predict postoperative outcomes following shoulder arthroscopy, which may cause moderate-to-severe pain. Methods In this prospective study, 100 shoulder arthroscopy patients completed preoperative validated self-report measures to assess baseline quality of recovery score, physical functioning, depression/anxiety, and neuropathic pain. Fibromyalgia characteristics were evaluated using a validated measure of widespread pain and comorbid symptoms on a 0–31 scale. Outcomes were assessed on postoperative days 2 (opioid consumption [primary], pain, physical functioning, quality of recovery score) and 14 (opioid consumption, pain). Results Fibromyalgia survey scores ranged from 0–13. The cohort was divided into tertiles for univariate analyses. Preoperative depression/anxiety (p<0.001) and neuropathic pain (p=0.008) were higher, and physical functioning was lower (p<0.001), in higher fibromyalgia survey score groups. The fibromyalgia survey score was not associated with postoperative pain or opioid consumption; however, it was independently associated with poorer quality of recovery scores (p=0.001). The only independent predictor of postoperative opioid use was preoperative opioid use (p=0.038). Discussion Fibromyalgia survey scores were lower than those in a previous study of joint arthroplasty. Although they distinguished a negative preoperative pain phenotype, fibromyalgia scores were not independently associated with postoperative opioid consumption. Further research is needed to elucidate the impact of a fibromyalgia-like phenotype on postoperative analgesic outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Fibromyalgia Survey Score Correlates With Preoperative Pain Phenotypes But Does Not Predict Pain Outcomes After Shoulder Arthroscopy

Cheng

Kahn

YaDeau

et al. 2016

The Clinical Journal of Pain

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“…21 These consequences likely are the unintended effect of a well-intentioned attempt to treat pain and should be considered by the surgeon when counseling at-risk patients on surgical treatment. 23 Regarding shoulder arthroscopy specifically, a prospective study of 231 procedures consisting of either rotator cuff repair, decompression procedures without rotator cuff repair, or instability procedures, examined the pattern of postoperative pain. 22 In other areas of shoulder and elbow surgery, preoperative pain and anticipated postoperative pain were found to be significant predictors of increased postoperative pain in a prospective study.…”

Section: Risk Factorsmentioning

confidence: 99%

Pain after rotator cuff repair

Roberson

Throckmorton

2016

Current Orthopaedic Practice

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Rotator cuff repair is known to be a painful procedure and therefore an area of particular focus in the perioperative period. The operating surgeon must be aware of several patient-specific risk factors that augment this response and be prepared to either deal with these preoperatively or augment pain management strategies postoperatively in select groups. Among the highest risk patients are those with mood disorders and those taking narcotic pain medication preoperatively. Additional technical risk factors for increased pain include concomitant procedures performed at the time of rotator cuff repair. Although performing these surgeries arthroscopically may provide early decreased pain and earlier treatment effects, there does not appear to be a long-term difference in terms of pain between arthroscopic and mini-open rotator cuff repair techniques. Anesthesia options exist for the benefit of postoperative pain, and these may be considered in the hands of the experienced and skilled anesthesiologist. Multimodal pain management provides a burgeoning area for continued improvement in conjunction with these other areas.

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“…[1] In the year of 2011, there were 53,000 shoulder arthroplasties performed annually in United States. [2] Traditional postoperative pain control has centered on the use of parenteral narcotics in the hospital, which have well-known side effects of respiratory depression, somnolence, and inconsistent pain relief. [3,4] Efficacy pain control after surgery may improve pain control and decreased the length of stay.…”

Section: Introductionmentioning

confidence: 99%

Liposomal bupivacaine versus interscalene nerve block for pain control after shoulder arthroplasty

Zeng

Zong

2017

Medicine

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Background:Postoperative pain control after total shoulder arthroplasty (TSA) can be challenging. Liposomal bupivacaine and interscalene nerve block are 2 common pain control protocol for TSA patients. However, whether liposomal bupivacaine was superior than interscalene nerve block was unknown. This meta-analysis aimed to illustrate the efficacy liposomal bupivacaine versus interscalene nerve block for pain control in patients undergoing TSA.Methods:In May 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google database. Data on patients prepared for TSA in studies that compared liposomal bupivacaine versus interscalene nerve block were retrieved. The endpoints were the visual analogue scale (VAS) at 4 hours, 8 hours, 12 hours, 24 hours, and 2 weeks, total morphine consumption at 24 hours, and the length of hospital stay. Software of Stata 12.0 was used for pooling the final outcomes.Results:Five clinical studies with 573 patients (liposomal bupivacaine group = 239, interscalene nerve block group = 334) were ultimately included in the meta-analysis. There was no significant difference between the VAS at 4 hours, 8 hours, and 2 weeks between liposomal bupivacaine group and interscalene nerve block group (P > .05). Compared with interscalene nerve block group, liposomal bupivacaine was associated with a reduction of VAS score at 12 hours, 24 hours by appropriately 3.31 points and 6.42 points respectively on a 100-point VAS. Furthermore, liposomal bupivacaine was associated with a significantly reduction of the length of hospital stay by appropriately by 0.16 days compared with interscalene nerve block group.Conclusion:Current meta-analysis indicates that compared with interscalene nerve block, liposomal bupivacaine had comparative effectiveness on reducing both pain scores and the length of hospital stay. However, studies with more patients and better-designed methods are needed to establish the optimal regimen and the safety of liposomal bupivacaine in TSA patients.

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Postoperative pain associated with orthopedic shoulder and elbow surgery: a prospective study

Cited by 17 publications

References 79 publications

The Fibromyalgia Survey Score Correlates With Preoperative Pain Phenotypes But Does Not Predict Pain Outcomes After Shoulder Arthroscopy

The Fibromyalgia Survey Score Correlates With Preoperative Pain Phenotypes But Does Not Predict Pain Outcomes After Shoulder Arthroscopy

Pain after rotator cuff repair

Liposomal bupivacaine versus interscalene nerve block for pain control after shoulder arthroplasty

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