Acetaminophen, naproxen and post arthroplasty pain control
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Multimodal analgesia decreases opioid consumption after shoulder arthroplasty: a prospective cohort study
These authors conducted a prospective cohort analysis of patients undergoing elective shoulder arthroplasty who were treated with either a standard opioid-based regimen or a multimodal analgesia regimen perioperatively.
Patients in both groups received a preoperative single-shot interscalene regional nerve block with 15-20 mL of 0.5% ropivacaine.
Patients treated with the multimodal analgesia regimen had significantly lower postoperative day 0 pain scores (mean, 1.5 vs 2.2; P = .027).
Opioid use in the multimodal cohort was lower on all days: 47% lower on postoperative day 0, 37% on day 1, and 44% on day 2 (all P < .01).
Comment: This study shows that the multimodal program resulted in less opiate use after surgery. It is not clear which elements of the multimodal program are most important. While we do not use gabapentin or lyrica in our practice because of the potential for side effects, we find, as did the authors, that scheduled Tylenol and Naproxen are most helpful in postoperative pain control.
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These authors conducted a prospective cohort analysis of patients undergoing elective shoulder arthroplasty who were treated with either a standard opioid-based regimen or a multimodal analgesia regimen perioperatively.
Collection was performed sequentially: the first 75 patients treated with the standard regimen, followed by 75 patients treated with the multimodal regimen. Patients with high preoperative chronic opioid use (defined as >60 mg of oral morphine equivalents taken daily) and patients with active infection undergoing removal of implants were excluded.
Patients in the standard group received scheduled doses of an opioid and acetaminophen combination medication postoperatively, with additional opioid medications as needed for pain control.
Multimodal patients received scheduled doses of non-opioid analgesics preoperatively and postoperatively, with additional opioid medications as needed for pain control.
Patients treated with the multimodal analgesia regimen had significantly lower postoperative day 0 pain scores (mean, 1.5 vs 2.2; P = .027).
The length of inpatient stay was significantly shorter for multimodal patients than for patients treated with the standard regimen (1.44 days vs 1.91 days, P < .01) as shown below. Parenthetically, this chart demonstrates that the cost of the implant is almost half of the hospital costs.
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The reader may also be interested in these posts:
Consultation for those who live a distance away from Seattle.
Click here to see the new Shoulder Arthritis Book.
Click here to see the new Rotator Cuff Book
Information about shoulder exercises can be found at this link.
Use the "Search" box to the right to find other topics of interest to you.
You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
See from which cities our patients come.
See the countries from which our readers come on this post.
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