Shoulder replacement is a big surgery for the big problem of shoulder arthritis. From decades of experience partnering with patients during their recovery, we have learned some steps than can ease and speed the shoulder's recovery while working to maintain the range of motion achieved at surgery. To emphasize, "partnering" is the key word here: active interaction between the patient and surgical team before and after surgery is essential.
Optimal pain management starts before surgery, assuring that the patient understands both the magnitude of the procedure as well as his or her essential role in carrying through with the potentially uncomfortable rehabilitation program that is essential to recovery. It is important to recognize that much of the discomfort comes from regaining the lost flexibility and muscle function resulting from long standing arthritis. Being prepared for the postoperative rehabilitation before surgery goes a long way toward understanding and managing postoperative pain. Many patients find that becoming familiar with the exercise program before surgery makes it easier to get started after surgery. See a link to some of the commonly used exercises here.
We have learned that giving a combination of medications immediately prior to surgery can lessen postoperative discomfort. Medications such as acetaminophen (Tylenol), anti-inflammatory medications (such as Toradol, Celebrex, or Aleve), a narcotic, and possibly Gabapentin each operate on different aspects of the pain pathway so that they work collaboratively. Of course, patients who are taking narcotic medication before surgery may have a more difficult time with pain management after surgery and may require an individual analysis of their situation before surgery.
In contrast to some surgeons, we do not find that single shot or continuous infusion pain catheters are particularly helpful or cost effective (see this link). Instead we find that the rapid transition from intravenous medications to scheduled acetominophen+scheduled anti-inflammatory+low dose oral narcotics for break through pain is very effective in enabling patients to successfully execute their stretching exercises on the same day as their ream and run or total shoulder arthroplasty and be ready for discharge from the hospital the same day or the day following their surgery.
