Multimodal Pain Management Protocol Versus Patient Controlled Narcotic Analgesia for Postoperative Pain Control after Shoulder Arthroplasty

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Nicholson Thema; Maltenfort Mitchell; Getz Charles; Lazarus Mark; Williams Gerald; Namdari Surena

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Journal Paper

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Journal: Archives of Bone and Joint Surgery Year:2018 | Volume:6 | Issue:3 Page(s): 196-202

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Title

Multimodal Pain Management Protocol Versus Patient Controlled Narcotic Analgesia for Postoperative Pain Control after Shoulder Arthroplasty

Author(s)

Keywords

Arthroplasties

Multimodal pain management

Pain management

Pain-postoperative

Shoulder arthroplasty

Abstract

Background: Our institution’ s traditional Pain management strategy after Shoulder arthroplasty has involved the utilization of postoperative patient-controlled narcotic analgesia. More recently, we have implemented a protocol (TLC) that utilizes a multimodal approach. The purpose of this study was to determine whether this change has improved pain control and decreased narcotic utilization. Methods: Patients undergoing primary total shoulder or reverse arthroplasty were retrospectively studied. All patients underwent interscalene brachial plexus blockade. “ Traditional” patients were provided a patient-controlled analgesic pump postoperatively. TLC patients were given preoperative and postoperative multimodal, non-narcotic analgesic medications and breakthrough narcotics. Morphine equivalent units (MEU) consumed and Visual Analog Scale (VAS) scores for pain (0, 8, 16, and 24 hours) were considered. Results: There were 108 patients in each group. Total postoperative narcotic consumption in the first 24 postoperative hours was 38. 5 +/-81. 1 MEU in the “ Traditional group” compared to 59. 3 +/-59. 1 MEU in the TLC group (P<0. 001). Of patients in the TLC group, 88% utilized breakthrough narcotics. VAS pain was significantly higher in the “ Traditional group” at 16 hours (4. 1 +/-2. 9 vs 3. 2 +/-2. 7, P=0. 020) and 24 hours (4. 8 +/-2. 7 vs 3. 7 +/-2. 6, P=0. 004). Conclusion: Those treated with the TLC protocol had greater narcotic utilization but better VAS pain scores at 24 hours after surgery. Both groups experienced rebound pain. While the TLC protocol led to an improved pain experience, further modification of the currently protocol may be necessary to reduce overall narcotic utilization.

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APA: Copy

Nicholson, Thema, Maltenfort, Mitchell, Getz, Charles, Lazarus, Mark, Williams, Gerald, & Namdari, Surena. (2018). Multimodal Pain Management Protocol Versus Patient Controlled Narcotic Analgesia for Postoperative Pain Control after Shoulder Arthroplasty. THE ARCHIVES OF BONE AND JOINT SURGERY, 6(3), 196-202. SID. https://sid.ir/paper/350115/en

Vancouver: Copy

Nicholson Thema, Maltenfort Mitchell, Getz Charles, Lazarus Mark, Williams Gerald, Namdari Surena. Multimodal Pain Management Protocol Versus Patient Controlled Narcotic Analgesia for Postoperative Pain Control after Shoulder Arthroplasty. THE ARCHIVES OF BONE AND JOINT SURGERY[Internet]. 2018;6(3):196-202. Available from: https://sid.ir/paper/350115/en

IEEE: Copy

Thema Nicholson, Mitchell Maltenfort, Charles Getz, Mark Lazarus, Gerald Williams, and Surena Namdari, “Multimodal Pain Management Protocol Versus Patient Controlled Narcotic Analgesia for Postoperative Pain Control after Shoulder Arthroplasty,” THE ARCHIVES OF BONE AND JOINT SURGERY, vol. 6, no. 3, pp. 196–202, 2018, [Online]. Available: https://sid.ir/paper/350115/en

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