Current pain prescribing habits for common shoulder operations: a survey of the American Shoulder and Elbow Surgeons membership

J Shoulder Elbow Surg. 2018 Jun;27(6S):S76-S81. doi: 10.1016/j.jse.2017.10.005. Epub 2017 Dec 14.

Abstract

Background: Orthopedic surgeons are among the highest prescribers of narcotic pills, and no guidelines currently exist for appropriate management of postoperative pain within this field. The purpose of this study was to gain understanding of the current pain management strategies used perioperatively and postoperatively among orthopedic shoulder surgeons.

Methods: Members of the American Shoulder and Elbow Surgeons were e-mailed an online survey regarding methods for managing pain in the perioperative and postoperative setting for total shoulder arthroplasty, labral and capsular stabilization procedures, and rotator cuff repair. Postoperative narcotic prescribing amounts were converted into oral morphine equivalents.

Results: The survey response rate was 25.8% (170/658), with >90% of surgeons reporting use of a standard pain management regimen in the perioperative and postoperative periods. A regional nerve block was used on the operative day by >80% of surgeons for all 3 procedures. Short-acting narcotics are prescribed for postoperative pain control by >85% of surgeons, with long-acting narcotics provided by <14%. More than 400 oral morphine equivalents of short-acting narcotic are prescribed by shoulder surgeons. Referral to a pain specialist or primary care physician is made after 12 weeks by 92.3% of surgeons if patients continue to require narcotic painkillers.

Conclusion: The majority of shoulder surgeons use a standard pain management protocol in perioperative and postoperative settings. Regimens frequently include a regional nerve block, nonsteroidal anti-inflammatory drugs, and short-acting oral narcotics. Findings from this study provide guidelines on standard pain management strategies for common shoulder operations based on expert opinion.

Keywords: Acute pain; opioid prescription; pain management; rotator cuff repair; shoulder stabilization; total shoulder arthroplasty.

MeSH terms

  • Analgesics, Opioid / therapeutic use*
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Arthroplasty, Replacement, Shoulder / adverse effects
  • Drug Prescriptions / statistics & numerical data
  • Humans
  • Morphine / therapeutic use*
  • Narcotics / therapeutic use*
  • Nerve Block
  • Pain Management / methods*
  • Pain Measurement
  • Pain, Postoperative / therapy*
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Referral and Consultation
  • Rotator Cuff Injuries / surgery
  • Surveys and Questionnaires
  • United States

Substances

  • Analgesics, Opioid
  • Anti-Inflammatory Agents, Non-Steroidal
  • Narcotics
  • Morphine