Multimodal analgesia decreases opioid consumption after shoulder arthroplasty: a prospective cohort study

J Shoulder Elbow Surg. 2018 Apr;27(4):686-691. doi: 10.1016/j.jse.2017.11.015. Epub 2018 Jan 3.

Abstract

Background: Studies on perioperative pain control in shoulder arthroplasty focus on regional anesthesia, with little research on other approaches. Perioperative multimodal analgesia regimens decrease opioid intake and opioid-related side effects in lower-extremity arthroplasty. In this study we compare pain scores, opioid consumption, length of stay, and readmission rates in postoperative shoulder arthroplasty patients treated with a standard or multimodal analgesia regimen.

Methods: A prospective cohort analysis was performed at a single institution. Patients undergoing elective shoulder arthroplasty were treated with either a standard opioid-based regimen or a multimodal analgesia regimen perioperatively. Outcome measures included inpatient pain scores, opioid use, length of stay, and 30- and 90-day emergency department visits and readmission rates.

Results: Seventy-five patients were included in each cohort. Patients treated with the multimodal analgesia regimen had 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). 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). There was no difference in the rate of 30- or 90-day emergency department visits or readmission.

Conclusion: Patients undergoing shoulder arthroplasty have decreased postoperative pain and opioid consumption and shorter hospital stays when given a multimodal analgesia regimen. There is no increase in short-term complications or unplanned readmissions, indicating that this is a safe and effective means to control postoperative pain.

Keywords: Shoulder arthroplasty; multimodal analgesia; opioid use; pain control; perioperative analgesia; postoperative length of inpatient stay.

MeSH terms

  • Acetaminophen / therapeutic use
  • Aged
  • Analgesics, Non-Narcotic / therapeutic use
  • Analgesics, Opioid / therapeutic use*
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Arthroplasty, Replacement, Shoulder*
  • Cohort Studies
  • Drug Therapy, Combination
  • Drug Utilization / statistics & numerical data
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Humans
  • Length of Stay
  • Male
  • Nerve Block
  • Pain Measurement
  • Pain, Postoperative / prevention & control*
  • Patient Readmission / statistics & numerical data

Substances

  • Analgesics, Non-Narcotic
  • Analgesics, Opioid
  • Anti-Inflammatory Agents, Non-Steroidal
  • Acetaminophen