Innovative patient education and pain management protocols to achieve opioid-free shoulder arthroplasty

Vani J Sabesan; Kiran Chatha; Sandra Koen; Mirelle Dawoud; Gregory Gilot

doi:10.1016/j.jseint.2020.01.005

Innovative patient education and pain management protocols to achieve opioid-free shoulder arthroplasty

JSES Int. 2020 May 4;4(2):362-365. doi: 10.1016/j.jseint.2020.01.005. eCollection 2020 Jun.

Authors

Vani J Sabesan¹, Kiran Chatha¹, Sandra Koen¹, Mirelle Dawoud², Gregory Gilot¹

Affiliations

¹ Levitetz Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
² Charles E. Schmidt School of Medicine, Florida Atlantic University, Boca Raton, FL, USA.

Abstract

Background: The creation of pain as the fifth vital sign led to skyrocketing opioid prescriptions and a crisis with addiction and abuse among Americans. The purpose of this study was to evaluate the effectiveness of a patient engagement model including education and innovative opioid-free multimodal pain management to achieve an opioid-free recovery after shoulder arthroplasty (SA).

Methods: Fifty patients undergoing SA were divided into 2 groups. In the opioid-free group (OFG), patients received additional preoperative education in combination with an innovative non-opioid multimodal pain management protocol and non-opioid alternatives. Patients were compared regarding pain levels and opioid consumption at 48 hours and at 2 weeks, as well as patient-reported outcome measures, using Student t tests.

Results: No significant differences were found in age (average, 69.76 years) (P = .14), American Society of Anesthesiologists grade (average, 2.25) (P = .24), sex, body mass index (average, 29.5) (P = .34), or comorbidity burden. In the OFG, 24% of patients reported use of rescue opioids (<2 pills) within the first 48 hours after surgery with complete cessation by 2 weeks postoperatively. Comparatively, in the control group, 100% of patients reported using opioids in the first 48 hours after surgery and 80% reported still taking opioids at 2 weeks postoperatively. Patients in both groups showed significant improvements in outcome scores (P ≤ .05), with the OFG reporting significantly higher American Shoulder and Elbow Surgeons pain (P = .036) and Constant (P = .005) scores.

Conclusions: Our findings support complete elimination of opioid use by 2 weeks after SA using a patient engagement model with non-opioid-based alternative pain management. The elimination of opioid pain management did not diminish outcomes or patient satisfaction after SA.

Keywords: Opioid use; non-opioid alternatives; opioid dependence; pain management; patient education; shoulder arthroplasty.