An integrated educational and multimodal approach to achieving an opioid-free postoperative course after arthroscopic rotator cuff repair

• Main Authors: Vani J. Sabesan, MD, Kiran Chatha, MD, Sandra Koen, ATC, Nikolas Echeverry, BS, Wilfredo J. Borroto, BS, Laila H. Khoury, BS, B. Joshua Stephens, BS, Gregory Gilot, MD
• Format: Article
• Language: English
• Published: Elsevier 2021-09-01
• Series: JSES International
• Subjects: Opioid use; Rotator cuff repair; Opioid dependence; Multimodal pain management; Patient education; Nonopioid alternatives
• Online Access: http://www.sciencedirect.com/science/article/pii/S2666638321000591

Background: In the realm of shoulder surgery, arthroscopic rotator cuff repair (RCR) is one of the most painful procedures and is often associated with higher opioid consumption. The purpose of this study was to evaluate effectiveness of preoperative and postoperative patient education and multimodal pain management to achieve an opioid-free postoperative recovery after RCR. Methods: Sixty patients who underwent RCR were divided in 2 groups. All patientsreceived an interscalene nerve block and multimodal pain management. The opioid intervention group (OIG) in addition received preoperative education on expectations of pain, non opioid pain protocols, and alternate therapiesto minimize pain as well as customized postoperative instructions. Patients were compared on pain levels, opioid consumption, and outcomes scores preoperatively and at 48 hours, 2 weeks, and final follow-up. Patient-reported outcomes and opioid usage were compared and analyzed using student’s t-tests and logistic regression. Results: At 48 hours, 15% of OIG patients reported use of rescue opioids after surgery compared with 100% of control group patients. Zero percent of OIG patients reported opioid use at 2 weeks compared to 90% of control group patients (P = .0196). Patients in both groups showed significant improvements in all outcome scores (P ≤ .05). At 6 weeks, functional, Constant, and satisfaction outcome scores were all higher in the OIG (P < .05). At last follow-up, there were no significant differences for all patient-reported outcomes between groups. Conclusions: Application of patient education tools and innovative multimodal pain management protocols successfully eliminates the need for opioids while maintaining excellent patient satisfaction and outcomes.