Purpose
To evaluate the efficacy of a multimodal nonopioid analgesic protocol in controlling
postoperative pain compared to opioids following a primary arthroscopic rotator cuff
repair.
Methods
Seventy consecutive patients undergoing a primary rotator cuff repair were assessed
for eligibility. An observer-blinded prospective randomized controlled trial was designed
in accordance with the Consolidated Standards of Reporting Trials 2010 (CONSORT) statement.
The two arms of the study included a multimodal nonopioid pain regimen for the experimental
group, and a standard of care narcotics for the control group. The primary outcome
was visual analog scale (VAS) pain scores for the first 10 postoperative days. Secondary
outcomes included PROMIS-PI (Patient-Reported Outcomes Measurement Information System-Pain
Interference) scale, patient satisfaction, and adverse drug events.
Results
Thirty patients declined to participate or were excluded, and 40 patients were included
in the final analysis. A total of 23 patients were in the traditional group, and 17
patients were in the nonopioid group. Control patients on opioid pain management reported
a significantly higher VAS pain score on postoperative day 1 (opioid: 5.7 ± 2, nonopioid:
3.7 ± 2.2; P = .011) and postoperative day 4 (opioid: 4.4 ± 2.7, nonopioid: 2.4 ± 2.2; P = .023). No significant difference was seen on any other postoperative day. When
mixed measured models were used to control for confounding factors, the nonopioid
group demonstrated significantly lower VAS and PROMIS-PI scores (P < .01) at every time point. Patients in the traditional analgesia group reported
significantly more days with constipation (P = .003) and days with upset stomach (P = .020) than those in the nonopioid group.
Concussion
The present study found that a multimodal nonopioid pain protocol provided equivalent
or better pain control compared to traditional opioid analgesics in patients undergoing
primary arthroscopic rotator cuff repair. Minimal side effects were noted with some
improvement in the multimodal nonopioid pain cohort. All patients reported satisfaction
with their pain management.
Level of Evidence
Level I, prospective randomized controlled trial.
Key Words
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Article info
Publication history
Published online: November 25, 2021
Accepted:
November 14,
2021
Received:
August 4,
2021
See commentary on page 1086Footnotes
The authors report the following potential conflicts of interest or sources of funding: V.M. reports travel and lodging support from Stryker and Smith & Nephew and educational support from Arthrex, outside the submitted work. T.R.J. reports educational support from Pinnacle, nonfinancial support from Exatech, outside the submitted work. K.R.O. reports educational support and hospitality payments from Arthrex, Smith & Nephew, and Zimmer, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2021 by the Arthroscopy Association of North America
