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Original research
Multimodal pain management and postoperative outcomes in inpatient and outpatient shoulder arthroplasties: a population-based study
  1. Helen Liu1,
  2. Haoyan Zhong2,
  3. Nicole Zubizarreta3,
  4. Paul Cagle4,
  5. Jiabin Liu2,
  6. Jashvant Poeran3,4 and
  7. Stavros G Memtsoudis2
  1. 1Icahn School of Medicine at Mount Sinai, New York, New York, USA
  2. 2Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
  3. 3Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  4. 4Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  1. Correspondence to Dr Jashvant Poeran, Institute for Healthcare Delivery Science, Department of Population Health Science and Policy/Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; jashvant.poeran{at}mountsinai.org

Abstract

Introduction Multimodal analgesia has been associated with reduced opioid utilization, opioid-related complications, and improved recovery in various orthopedic surgeries; however, large sample size data is lacking for shoulder surgery.

Methods A retrospective review using the Premier Healthcare Database of patients who underwent inpatient or outpatient (reverse, total, partial) shoulder arthroplasty from 2010 to 2019. Opioid-only analgesia was compared with multimodal analgesia, categorized into 1, 2, or >2 additional analgesic modes, with/without a nerve block. Multivariable regression models measured associations between multimodal analgesia and opioid charges (in oral morphine equivalents (OME)), cost and length of stay, and opioid-related adverse effects (approximated by naloxone use). We report % change and 95% CIs.

Results Among 176 225 procedures, 169 679 (75.7% multimodal analgesia use) and 6546 (37.8% multimodal analgesia use) were inpatient and outpatient shoulder arthroplasties, respectively. Among inpatients, multimodal analgesia (>2 modes) without a nerve block (vs opioid-only analgesia) was associated with adjusted reductions in OMEs on postoperative day 1: −19.4% (95% CI −21.2% to −17.6%/representing unadjusted median OME reductions from 45 to 30 mg). For total hospitalization, this was −6.0% (95% CI −7.2% to −4.9%/representing unadjusted median OME reductions from 173 to 135 mg). Conversely, for outpatients, this was +13.7% change in OMEs (95% CI +4.4% to +23.0%/representing unadjusted median OME increases from 110 to 131 mg). In both settings, addition of a nerve block to multimodal analgesia attenuated effects in terms of opioid charges.

Conclusions Multimodal analgesia is associated with reductions in opioid charges—specifically inpatient setting—but not various other outcomes.

  • analgesia
  • analgesics, opioid
  • pain, postoperative
  • acute pain

Data availability statement

Data may be obtained from a third party and are not publicly available. Data obtained from Premier Healthcare Database (Premier Healthcare Solutions, Inc., USA).

https://doi.org/10.1136/rapm-2023-104984

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Data obtained from Premier Healthcare Database (Premier Healthcare Solutions, Inc., USA).

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    Footnotes

    • Twitter @jbLiujb, @jashvant_p, @sgmemtsoudis

    • Contributors HL, HZ, and NZ contributed to the study design, implementation of the research, analysis of results, and writing of the manuscript. PC, JL, JP, and SGM contributed to the study design, analysis of results, review of manuscript, editing, and study direction and planning. JP accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.