Multimodal Pain Management Protocol Versus Patient Controlled Narcotic Analgesia for Postoperative Pain Control after Shoulder Arthroplasty
Article Type:
Research/Original Article (دارای رتبه معتبر)
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
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.
Language:
English
Published:
Archives of Bone and Joint Surgery, Volume:6 Issue: 3, May 2018
Pages:
196 to 202
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