Opioid-free shoulder arthroplasty: a prospective study of a novel clinical care pathway

• Published in: Journal of shoulder and elbow surgery Vol. 28; no. 9; pp. 1716 - 1722
• Main Authors: Leas, Daniel P., Connor, Patrick M., Schiffern, Shadley C., D’Alessandro, Donald F., Roberts, Katherine M., Hamid, Nady
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2019
• Subjects: Aged; Aged, 80 and over; Analgesics - therapeutic use; Anesthetics - therapeutic use; Anesthetics, Local - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Arthroplasty; Arthroplasty, Replacement, Shoulder; Bupivacaine - administration & dosage; Critical Pathways; Cryotherapy; Feasibility Studies; Female; Humans; Injections, Intra-Articular; Male; Middle Aged; multimodal; Nerve Block; opioid; opioid-free; pain; Pain Management - methods; Pain Measurement; Pain, Postoperative - therapy; Perioperative Care; Prospective Studies; shoulder; Treatment Study; Level IV; pain; Case Series; opioid; Arthroplasty; multimodal; opioid-free; shoulder
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2019.01.013

Opioid therapy has been a cornerstone of perioperative pain control for decades in the United States, despite our increased understanding of the morbidity and mortality linked to opioids. The purpose of this study is to explore the safety, efficacy, and feasibility of an entirely opioid-free perioperative pathway in patients undergoing elective shoulder arthroplasty. Thirty-five patients undergoing elective total shoulder arthroplasty with a mean age of 71 (range, 50-87) years elected into a comprehensive opioid-free, multimodal pain management protocol. Opioid use was completely eliminated for all points in the perioperative period including during regional and general anesthesia. Data were collected regarding patient-reported pain, opioid consumption in the perioperative period, postoperative delirium, nausea, constipation, and falls. Pain level at the primary outcome point of 24 hours or discharge was rated at 2.5 on the numeric rating scale. Stable, low pain scores were demonstrated at all time points postoperatively. Low rates of nausea, falls, and constipation were reported. Only 1 patient required “rescue” opioid medications during the in-patient stay, and an additional patient was given a low-dose opioid prescription at the 2-week postoperative appointment. An opioid-free, multimodal pain management pathway is a safe and effective option in properly selected patients undergoing shoulder arthroplasty with a very low risk of requiring rescue opioids. This study is the first such study to present a surgical protocol entirely free of opioids at all portions of the patient care pathway.