Friday, March 18, 2016

Narcotics and shoulder arthroplasty outcomes - some answers and some questions

Preoperative opioid use associated with worse outcomes after anatomic shoulder arthroplasty.

These authors report on 224 TSAs performed for primary glenohumeral joint osteoarthritis with 2- to 5-year follow-up. Sixty patients with a history of preoperative opioid use for shoulder pain were compared with a control group of 164 patients. Preoperative opioid use was determined prospectively by asking, "Do you take narcotic pain medication (codeine or stronger) for your shoulder?"

Preoperative opioid use was significantly associated with female sex, chronic back pain, depression, increased pain, lower activity, lower strength, and less range of motion.

The magnitude of change between the groups from preoperatively to the most recent follow-up was similar for all measures and range of motion measurements.

There was a statistical difference between the 2 groups in terms of the number of satisfied patients (opioid group, 48 of 60 [80%] vs. nonopioid group, 149 of 164 [91%]; P . .03).

Comments:  As pointed out in prior posts, preoperative opioid use has been associated with worse clinical outcomes after total knee arthroplasty, spine surgery, and more recently reverse TSA.

Several questions arise:
(1) This study used a 'yes' or 'no' question to determine opioid use, does the amount of narcotic matter?
(2) How should these data be used in counseling patients and in surgical decision making?
(3) Is preoperative narcotic detoxification improve outcomes?
(4) How does preoperative narcotic medication affect postoperative pain management?