PMID- 35286469
OWN - NLM
STAT- MEDLINE
DCOM- 20230426
LR  - 20230426
IS  - 1432-1068 (Electronic)
IS  - 1633-8065 (Linking)
VI  - 33
IP  - 4
DP  - 2023 May
TI  - Early reduction in postoperative pain is associated with improved long-term 
      function after shoulder arthroplasty: a retrospective case series.
PG  - 1023-1030
LID - 10.1007/s00590-022-03242-x [doi]
AB  - PURPOSE: Mixed modalities are frequently utilized in total shoulder arthroplasty 
      (TSA) to control pain, improve patient satisfaction, reduce narcotics use and 
      facilitate earlier discharge. We investigate the relationship between early 
      postoperative pain control and long-term functional outcomes after shoulder 
      arthroplasty. METHODS: A retrospective review identified 294 patients (314 
      shoulders) who underwent anatomic or reverse TSA and received a continuous 
      cervical paravertebral nerve block perioperatively. Opioid and non-opioid 
      analgesics were also available to the patients in an "as needed" capacity to 
      augment perioperative pain control. In addition to demographic and surgical 
      characteristics, the impact on functional outcomes of relative pain (i.e., a 
      patient's subjective pain relative to the entire cohort), pain gradient (i.e., 
      the slope of a patient's subjective pain), and opioid consumption during the 
      first 24 h postoperatively were assessed. Shoulder function was assessed using 
      validated outcome measures collected at 2 year follow-up. Outcomes were measured 
      using American Shoulder and Elbow Surgeons questionnaire (ASES), Shoulder Pain 
      and Disability Index (SPADI), SPADI-130, Raw and Normalized Constant Score, 
      SST-12 and UCLA score. RESULTS: Patients younger than 65, females, reverse TSA, 
      revisions, and preoperative opioid users had worse functional outcomes. On 
      univariate analysis, increased pain perioperatively (> 50% percentile relative 
      pain) was associated with decreased function at 2 years when analyzed with all 
      seven outcome scores (P < .001 for all), reaching minimal clinically important 
      difference (MCID) using the Constant Score. On multivariate analysis, increased 
      pain in the first 24 h postoperatively (assessed on a continuous scale) was 
      independently associated with worse ASES, SPADI, and SPADI-130 scores. 
      Intraoperative ketamine administration and opioid consumption in the 24 h 
      postoperative period did not influence long-term shoulder function. CONCLUSION: 
      Patients reporting reduced pain after TSA demonstrated improved shoulder function 
      with the Constant score at 2 years postoperatively in both univariate and 
      multivariate analysis. Larger-scale investigation may be warranted to see if this 
      is true for other functional outcome measures. LEVEL OF EVIDENCE: III, treatment 
      study.
CI  - (c) 2022. The Author(s), under exclusive licence to Springer-Verlag France SAS, 
      part of Springer Nature.
FAU - Judkins, Benjamin L
AU  - Judkins BL
AD  - Department of Orthopedic Surgery, Prisma Health - Upstate, Greenville, SC, USA.
FAU - Hao, Kevin A
AU  - Hao KA
AD  - College of Medicine, University of Florida, Gainesville, FL, USA.
FAU - Wright, Thomas W
AU  - Wright TW
AD  - Department of Orthopaedic Surgery and Sports Medicine, Orthopaedics and Sports 
      Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 
      32611, USA.
FAU - Jones, Braden K
AU  - Jones BK
AD  - Department of Orthopaedic Surgery and Sports Medicine, Orthopaedics and Sports 
      Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 
      32611, USA.
FAU - Boezaart, Andre P
AU  - Boezaart AP
AD  - Department of Anesthesiology, University of Florida, Gainesville, FL, USA.
AD  - Lumina Health Pain Medicine Collaborative, Surrey, UK.
FAU - Tighe, Patrick
AU  - Tighe P
AD  - Department of Anesthesiology, University of Florida, Gainesville, FL, USA.
FAU - Vasilopoulos, Terrie
AU  - Vasilopoulos T
AD  - Department of Anesthesiology, University of Florida, Gainesville, FL, USA.
FAU - Horodyski, MaryBeth
AU  - Horodyski M
AD  - Department of Orthopaedic Surgery and Sports Medicine, Orthopaedics and Sports 
      Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 
      32611, USA.
FAU - King, Joseph J
AU  - King JJ
AUID- ORCID: 0000-0002-9201-9408
AD  - Department of Orthopaedic Surgery and Sports Medicine, Orthopaedics and Sports 
      Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 
      32611, USA. kingjj@ortho.ufl.edu.
LA  - eng
PT  - Journal Article
DEP - 20220314
PL  - France
TA  - Eur J Orthop Surg Traumatol
JT  - European journal of orthopaedic surgery & traumatology : orthopedie traumatologie
JID - 9518037
SB  - IM
MH  - Female
MH  - Humans
MH  - *Arthroplasty, Replacement, Shoulder
MH  - Retrospective Studies
MH  - *Shoulder Joint/surgery
MH  - Patient Satisfaction
MH  - Pain, Postoperative
MH  - Shoulder Pain/surgery
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Anatomic
OT  - Nerve catheter
OT  - Opioid
OT  - Outcome score
OT  - Reverse
OT  - Shoulder replacement
EDAT- 2022/03/15 06:00
MHDA- 2023/04/26 06:41
CRDT- 2022/03/14 17:19
PHST- 2021/11/19 00:00 [received]
PHST- 2022/02/28 00:00 [accepted]
PHST- 2023/04/26 06:41 [medline]
PHST- 2022/03/15 06:00 [pubmed]
PHST- 2022/03/14 17:19 [entrez]
AID - 10.1007/s00590-022-03242-x [pii]
AID - 10.1007/s00590-022-03242-x [doi]
PST - ppublish
SO  - Eur J Orthop Surg Traumatol. 2023 May;33(4):1023-1030. doi: 
      10.1007/s00590-022-03242-x. Epub 2022 Mar 14.