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Souza VSD, Ribeiro HDW, Machado JC, Medeiros LF, Castro MS, Souza AD. Perfil Nociceptivo e Uso de Analgésicos em Pacientes Submetidos à Cirurgia de Reparo do Manguito Rotador: Coorte Prospectiva. Rev Bras Ortop 2021; 57:856-862. [PMID: 36226216 PMCID: PMC9550370 DOI: 10.1055/s-0040-1719087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022] Open
Abstract
Objective
This study aimed to evaluate the nociceptive profile and the intake of analgesic drugs of patients submitted to rotator cuff repair surgery. Also, to evaluate the nociceptive thresholds and the integrity of the descending inhibitory system, pain catastrophism and prevalence of nociceptive or neuropathic pain.
Methods
Approved by the Ethics Committee of La Salle University (1.325.433/2015). 40 patients (>18 years old) who underwent rotator cuff repair surgery (divided in small and large injuries) were recruited. The used instruments were: Sociodemographic Questionnaire, Functional Pain Scale, Visual Analogue Scale (VAS), Quantitative Sensory Test (QST) and Conditioned Pain Modulation Task (CPM).
Results
Patients had a significant difference in pain thresholds QST heat (independent samples
t
test) and quality of sleep, mood and anxiety (paired
t
test) in groups preoperative. There was a significant correlation between preoperative CPM and postoperative VAS (Pearson Correlation). It was observed that, in preoperative, 38 patients used analgesics continuously. Besides that, in postoperative, use of opioid drugs was higher in patients with small injury (13 patients) than in those with large injury (9 patients).
Conclusion
Therefore, patients with rotator cuff injuries did not present alterations in the descending inhibitory system, but showed alterations in pain thresholds, which may interfere in the postoperative period and still be related to the consumption of analgesics.
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Affiliation(s)
- Vanessa Silva de Souza
- Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Universidade La Salle, Canoas, RS, Brasil
- Hospital Independência, Divina Providência, Porto Alegre, RS, Brasil
| | - Hugo Daniel Welter Ribeiro
- Hospital Independência, Divina Providência, Porto Alegre, RS, Brasil
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Jéssica Catarina Machado
- Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Universidade La Salle, Canoas, RS, Brasil
| | | | - Mariane Schäffer Castro
- Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Universidade La Salle, Canoas, RS, Brasil
| | - Andressa de Souza
- Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Universidade La Salle, Canoas, RS, Brasil
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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An M, Su X, Wei M, Zhang B, Gao F, Hu B, Dong C, Liu Y, Qi W, Li C. Local anesthesia combined with intra-articular ropivacaine can provide satisfactory pain control in ankle arthroscopic surgery: A retrospective cohort study. J Orthop Surg (Hong Kong) 2021; 28:2309499020938122. [PMID: 32700623 DOI: 10.1177/2309499020938122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Local anesthesia (LA) is widely used in knee arthroscopic surgery but not in ankle arthroscopy. OBJECTIVE To understand the effectiveness and safety of LA combined with ropivacaine in pain control for ankle arthroscopy. STUDY DESIGN Retrospective cohort. METHODS We retrospectively collected data for patients who underwent ankle arthroscopy from April 2012 to April 2017. Patients were grouped by anesthesia method: LA, LA with ropivacaine (LA+R), spinal anesthesia (SA), and SA with ropivacaine (SA+R). Intra- and postoperative visual analog scale (VAS) scores, complications, doses of supplemental pain medication, hospitalization cost and duration, and satisfaction with pain control during hospitalization were analyzed. RESULTS The study included 276 patients (LA: 93; LA+R: 124; SA: 31; SA+R: 28). The LA and LA+R groups had significantly higher intraoperative VAS scores (LA vs. SA, p = 0.001; LA vs. SA+R, p = 0.002; LA+R vs. SA, p = 0.00; LA+R vs. SA+R, p = 0.00), but fewer complications, than the SA and SA+R groups. The LA+R and SA+R groups had significantly better outcomes for postoperative pain control (LA vs. LA+R, p = 0.01; LA vs. SA+R, p = 0.01; SA vs. SA+R, p = 0.01; SA vs. LA+R, p = 0.03) and required less supplemental pain medication. Hospitalization cost was lower and duration shorter in the LA and LA+R groups than in the SA and SA+R groups. There was no significant difference in satisfaction among the four groups. LIMITATIONS This was a single-center retrospective and relatively short-term study. CONCLUSIONS LA+R which could be safely applied in ankle arthroscopy provided satisfactory pain control, reduced postoperative pain intensity, fewer complications, shorter hospital stay, and good cost-effectiveness. It can be safely applied in ankle arthroscopy for the specific patients with ankle osteoarthritis.
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Affiliation(s)
- Mingyang An
- Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiangzheng Su
- Department of Emergency, the First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Min Wei
- Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Baiqing Zhang
- Department of Orthopedics Surgery, The Beijing Armed Police General Corps Hospital, Beijing, People's Republic of China
| | - Feng Gao
- Department of Sports Injury and Arthroscopy Surgery, National Institute of Sports Medicine, Beijing, People's Republic of China
| | - Bo Hu
- The Second Department of Orthopaedics, Beijing Chaoyang Integrative Medicine Emergency Medical Center, Beijing, People's Republic of China
| | - Chenhui Dong
- Department of Sports Medicine, Orthopedic Surgery and Research Centre of PLA, Hospital 940 of PLA Joint Logistics Support Force, Lanzhou, People's Republic of China
| | - Yujie Liu
- Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Wei Qi
- Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Chunbao Li
- Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
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Trasolini NA, Bolia IK, Kang HP, Essilfie A, Mayer EN, Omid R, Gamradt SC, Hatch GF, Weber AE. National Trends in Use of Regional Anesthesia and Postoperative Patterns of Opioid Prescription Filling in Shoulder Arthroscopy: A Procedure-Specific Analysis in Patients With or Without Recent Opioid Exposure. Orthop J Sports Med 2020; 8:2325967120929349. [PMID: 32637432 PMCID: PMC7313342 DOI: 10.1177/2325967120929349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background There are few large database studies on national trends in regional anesthesia for various arthroscopic shoulder procedures and the effect of nerve blocks on the postoperative rate of opioid prescription filling. Hypothesis The use of regional nerve block will decrease the rate of opioid prescription filling after various shoulder arthroscopic procedures. Also, the postoperative pattern of opioid prescription filling will be affected by the preoperative opioid prescription-filling history. Study Design Cohort study; Level of evidence, 3. Methods Patient data from Humana, a large national private insurer, were queried via PearlDiver software, and a retrospective review was conducted from 2007 through 2015. Patients undergoing arthroscopic shoulder procedures were identified through Current Procedural Terminology codes. Nerve blocks were identified by relevant codes for single-shot and indwelling catheter blocks. The blocked and unblocked cases were age and sex matched to compare the pain medication prescription-filling pattern. Postoperative opioid trends (up to 6 months) were compared by regression analysis. Results We identified 82,561 cases, of which 54,578 (66.1%) included a peripheral nerve block. Of the patients who received a block, 508 underwent diagnostic shoulder arthroscopy; 2449 had labral repair; 4746 had subacromial decompression procedure; and 12,616 underwent rotator cuff repair. The percentage of patients undergoing a nerve block increased linearly over the 9-year study period (R 2 = 0.77; P = .002). After matching across the 2 cohorts, there was an identical trend in opioid prescription filling between blocked and unblocked cases (P = .95). When subdivided by procedure, there was no difference in the trends between blocked and unblocked cases (P = .52 for diagnostic arthroscopies; P = .24 for labral procedures; P = .71 for subacromial decompressions; P = .34 for rotator cuff repairs). However, when preoperative opioid users were isolated, postoperative opioid prescription filling was found to be less common in the first 2 weeks after surgery when a nerve block was given versus not given (P < .001). Conclusion An increasing percentage of shoulder arthroscopies are being performed with regional nerve blocks. However, there was no difference in patterns of filled postoperative opioid prescriptions between blocked and unblocked cases, except for the subgroup of patients who had filled an opioid prescription within 1 to 3 months prior to shoulder arthroscopy. Future research should focus on recording the amount of prescribed opioids consumed in national databases to reinforce our strategy against the opioid epidemic.
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Affiliation(s)
- Nicholas A Trasolini
- USC Epstein Family Center for Sports Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Hyunwoo P Kang
- USC Epstein Family Center for Sports Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Anthony Essilfie
- USC Epstein Family Center for Sports Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Erik N Mayer
- Department of Orthopaedic Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Reza Omid
- USC Epstein Family Center for Sports Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Seth C Gamradt
- USC Epstein Family Center for Sports Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - George F Hatch
- USC Epstein Family Center for Sports Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Rasmussen JK, Nikolajsen L, Bjørnholdt KT. Acute postoperative pain after arthroscopic rotator cuff surgery: A review of methods of pain assessment. SICOT J 2018; 4:49. [PMID: 30465647 PMCID: PMC6250077 DOI: 10.1051/sicotj/2018042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 08/10/2018] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Pain can be severe during the first days after arthroscopic surgery, and acute pain is an important outcome in clinical trials of surgical technique or anaesthetic strategy. A standardized, validated method of assessing acute postoperative pain would improve the quality of clinical studies, and facilitate systematic reviews and meta-analyses. A step on the way towards this standard is to investigate the methods most commonly used in recent literature. METHODS PubMed and CINAHL databases were searched, including studies of arthroscopic rotator cuff surgery with a primary pain-related outcome during the first postoperative week, published in English from 2012 to 2017. RESULTS A total of 47 studies were included, all measuring pain intensity using a pain rating scale. Most frequently used was the visual analogue scale using the anchors "no pain" and "worst pain imaginable", with recordings at 1, 2, 4, 6, 8, 12, and 24 hours postoperatively. A total of 34 studies recorded analgesic consumption, usually as average cumulated consumption in mg. Time to first analgesic request or first pain were recorded in 11 studies, and 4 different starting points were used. DISCUSSION This review describes the currently most common methods of assessing acute postoperative pain in clinical trials of arthroscopic shoulder surgery involving rotator cuff repair, and the large variety of methods applied. Based on this study and international guidelines, several recommendations on how to measure and report postoperative pain outcomes in future trials are proposed.
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Affiliation(s)
| | - Lone Nikolajsen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Research, C319, Palle Juul Jensens Boulevard 99, Aarhus, Denmark
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