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Effect of Preoperative Opioid Usage on Pain After Total Shoulder Arthroplasty

Curtis, William BS; Rounds, Alexis D. BS; Stone, Michael MD; Vangsness, C. Thomas Jr MD; Weber, Alexander E. MD; Hatch, George F. “Rick” III MD; Omid, Reza MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: August 15, 2019 - Volume 27 - Issue 16 - p e734–e742
doi: 10.5435/JAAOS-D-18-00112
Research Article

Introduction: Preoperative opioid use has recently been associated with increased perioperative pain. This study evaluates the effect of preoperative opioid use on postoperative pain and duration of opioid use after total shoulder arthroplasty (TSA).

Methods: We retrospectively identified 138 TSAs (69.1% reverse and 30.9% anatomic) between January 2013 and April 2017 that met inclusion criteria. Patients were stratified into two groups based on opioid usage within the 4 weeks before surgery. Primary outcome was resting pain at 3 months postoperatively using a 10-point numerical rating scale system. Duration of postoperative opioid consumption was also recorded and compared between cohorts.

Results: The opioid cohort (n = 50) reported significantly greater resting pain and pain with activity at 3 months postoperatively, at which time the reported numerical rating scale pain scores were 1.6 and 2.8 points greater in the opioid cohort compared with the non-opioid cohort (P < 0.001). Preoperative opioid use strongly predicted postoperative opioid use at all follow-up time points (P < 0.0001).

Discussion: Preoperative opioid consumption is associated with higher pain and increased duration of opioid use after TSA.

From the Department of Orthopedic Surgery, Keck Medicine of University of Southern California, Los Angeles, CA.

Correspondence to Ms. Rounds:

This study was presented at the Western Orthopaedic Association Annual Meeting, August 2018, Snowmass, Colorado.

Dr. Vangsness or an immediate family member is an employee of Keralink; has stock or stock options held in Carthronix; and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel) from Lipogems. Dr. Hatch or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of and serves as a paid consultant to Arthrex. Dr. Omid or an immediate family member has received IP royalties from Integra and Medacta and serves as a paid consultant to Integra, Medacta, and Tornier. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Mr. Curtis, Ms. Rounds, Dr. Stone, and Dr. Weber.

© 2019 by American Academy of Orthopaedic Surgeons
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