Optimizing Pain Management Following Open Shoulder Surgery Arjun - - PowerPoint PPT Presentation
Optimizing Pain Management Following Open Shoulder Surgery Arjun Meiyappan MD 1 , Ahmed Al-Mansoori MD 1 , Sumit Kanwar 1 MD, Manisha R Chand MD 1 , Colin McNamara MD 2 , Vani Sabesan MD 1 , Gregory Gilot MD 1 1 Levitetz Department of Orthopaedic
Optimizing Pain Management Following Open Shoulder Surgery
Arjun Meiyappan MD 1, Ahmed Al-Mansoori MD 1, Sumit Kanwar 1 MD, Manisha R Chand MD 1, Colin McNamara MD2, Vani Sabesan MD 1, Gregory Gilot MD 1
1 Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL 2 Department of Orthopaedic Surgery, Miller School of Medicine, University of Miami, Miami, FL
Shoulder Arthroplasty One of the Most Painful Ambulatory Surgeries Requires Substantial Post-operative Pain-management Postoperative Pain Usually Controlled with Narcotics Opioid Addiction – An Epidemic in the US
To determine which pain management protocol is most efficient at reducing the use of narcotics after surgery
A novel non-opioid-based medication created for postoperative pain management for a multitude of orthopedic procedures Bupivacaine coated in Liposomal vesicles
A Prospective Clinical Trial of 47 Patients Who Underwent TSA, RSA or ORIF We looked at three different pain management systems for post-operative pain
Patients Were placed in 3 Groups:
Outcomes Compared: Visual Analogue Score (VAS) Total Morphine Equivalents (TME) Opioid Related Symptoms Distress Scale (OR-SDS)
No significant differences were found between the three groups at 1 day postoperatively based on VAS pain score and TME usage
3.11 4.78 5.18
1 2 3 4 5 6 7 8 9 10
Liposomal Bupivacaine Free Bupivicaine Pain Pump
VAS
P=0.12
51.82 53.05 46.63 10 20 30 40 50 60
Liposomal Bupivacaine Free Bupivicaine Pain Pump
TME
p=0.86
At 2 days postoperatively a significant difference was seen in VAS scores On post hoc analysis LB (3.2) was lower when compared to the Pain Pump (5.3) and FB (5.7)
40.2 39.7 34.3 10 20 30 40 50 60
Liposomal Bupivacaine Free Bupivicaine Pain Pump
TME
MEQ
3.2 5.7 5.3
1 2 3 4 5 6 7 8 9 10 Liposomal Bupivacaine Free Bupivicaine Pain Pump
VAS
VAS scores also showed a significant difference in the third post-operative day. A post hoc analysis showed LB had a lower VAS score 2.5 when compared to the pain pump 5.1 and FB 5.1 groups
2.5 5.1 5.1
1 2 3 4 5 6 7 8 9 10 Liposomal Bupivacaine Free Bupivicaine Pain Pump
VAS
32.2 31.8 30
10 20 30 40 50 60
Liposomal Bupivacaine Free Bupivicaine Pain Pump
TME
However even with these lowered pain scores narcotic consumption did not differ between the groups as a result Thus There was no significant benefit seen from the use of LB in opioid reduction post shoulder surgery