Multimodal Pain Management Protocol Versus Patient Controlled Narcotic Analgesia for Postoperative Pain Control after Shoulder Arthroplasty
محل انتشار: مجله استخوان و جراحی عمومی، دوره: 6، شماره: 3
سال انتشار: 1397
نوع سند: مقاله ژورنالی
زبان: انگلیسی
مشاهده: 310
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شناسه ملی سند علمی:
JR_TABO-6-3_006
تاریخ نمایه سازی: 18 تیر 1398
چکیده مقاله:
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<0.001). Of patients in the TLC group, 88% utilized breakthrough narcotics. VAS pain was significantly higher in the Traditional group at 16 hours (4.1 +/- 2.9 vs 3.2 +/- 2.7, P=0.020) and 24 hours (4.8 +/- 2.7 vs 3.7 +/- 2.6, P=0.004). 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. Level of evidence: III
کلیدواژه ها:
نویسندگان
Thema Nicholson
Department of Orthopaedic Surgery, Rothman Institute- Thomas Jefferson University, Philadelphia, PA, USA
Mitchell Maltenfort
Department of Orthopaedic Surgery, Rothman Institute- Thomas Jefferson University, Philadelphia, PA, USA
Charles Getz
Department of Orthopaedic Surgery, Rothman Institute- Thomas Jefferson University, Philadelphia, PA, USA
Mark Lazarus
Department of Orthopaedic Surgery, Rothman Institute- Thomas Jefferson University, Philadelphia, PA, USA