Increase in Deltoid Compartment Pressures Immediately After Arthroscopic Rotator Cuff Repair Does Not Significantly Affect Postoperative Opioid Consumption

Overview

Journal Arthrosc Sports Med Rehabil

Date 2023 Jul 26

PMID 37492561

Authors

Derrick M Knapik

Joseph E Tanenbaum

Michael J Salata

Brian N Victoroff

James E Voos

Robert J Gillespie

Affiliations

Soon will be listed here.

Abstract

Purpose: To investigate the association between changes in individual (anterior, lateral, and posterior) and overall deltoid compartment pressures and postoperative opioid consumption up to 14 days after primary double-row arthroscopic rotator cuff repair (ARCR).

Methods: In 113 consecutive patients undergoing primary double-row ARCR, anterior, lateral, and posterior deltoid compartment pressures were measured prior to incision and immediately after closure with a manometer. Postoperatively, all patients were provided with an identical rehabilitation protocol, quantity and dose of opioid tablets, and pain journal in which to record daily opioid consumption and visual analog scale pain scores for 14 days after surgery. The pain journals were collected at the first postoperative visit, and opioid consumption was calculated based on morphine equivalents. Statistical analysis was performed to determine the association between deltoid compartment pressures and opioid consumption postoperatively.

Results: Sixty-nine percent of patients who met the inclusion criteria (74 of 107) returned the pain journals. The mean age at the time of surgery was 57.4 ± 8.8 years (range, 30-75 years), with female patients being significantly older ( = .03). The mean length of surgery was 71.7 ± 16.3 minutes. No significant association between increase in individual (anterior, lateral, or posterior) or mean overall compartment pressures and morphine equivalents of opioid consumption was appreciated on any postoperative day.

Conclusions: No significant correlation between increase in individual or overall deltoid compartment pressures after ARCR and postoperative opioid consumption in the immediate postoperative period was found in this study.

Level Of Evidence: Level II, prospective cohort study.

References

Williams B, Redlich N, Mickschl D, Grindel S . Influence of preoperative opioid use on postoperative outcomes and opioid use after arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2018; 28(3):453-460. DOI: 10.1016/j.jse.2018.08.036. View

Williams Jr G, Kraeutler M, Zmistowski B, Fenlin Jr J . No difference in postoperative pain after arthroscopic versus open rotator cuff repair. Clin Orthop Relat Res. 2014; 472(9):2759-65. PMC: 4117892. DOI: 10.1007/s11999-014-3715-6. View

Kang L, Henn R, Tashjian R, Green A . Early outcome of arthroscopic rotator cuff repair: a matched comparison with mini-open rotator cuff repair. Arthroscopy. 2007; 23(6):573-82, 582.e1-2. DOI: 10.1016/j.arthro.2007.01.011. View

Cuff D, OBrien K, Pupello D, Santoni B . Evaluation of Factors Affecting Acute Postoperative Pain Levels After Arthroscopic Rotator Cuff Repair. Arthroscopy. 2016; 32(7):1231-6. DOI: 10.1016/j.arthro.2015.12.021. View

Chakravarthy B, Shah S, Lotfipour S . Prescription drug monitoring programs and other interventions to combat prescription opioid abuse. West J Emerg Med. 2013; 13(5):422-5. PMC: 3556951. DOI: 10.5811/westjem.2012.7.12936. View

Cho N, Ha J, Rhee Y . Patient-controlled analgesia after arthroscopic rotator cuff repair: subacromial catheter versus intravenous injection. Am J Sports Med. 2006; 35(1):75-9. DOI: 10.1177/0363546506291632. View

Kose K, Tezen E, Cebesoy O, Karadeniz E, Guner D, Adiyaman S . Mini-open versus all-arthroscopic rotator cuff repair: comparison of the operative costs and the clinical outcomes. Adv Ther. 2008; 25(3):249-59. DOI: 10.1007/s12325-008-0031-0. View

Westermann R, Anthony C, Bedard N, Glass N, Bollier M, Hettrich C . Opioid Consumption After Rotator Cuff Repair. Arthroscopy. 2017; 33(8):1467-1472. DOI: 10.1016/j.arthro.2017.03.016. View

De Wachter J, Van Glabbeek F, van Riet R, Van Leemput W, Vermeyen K, Somville J . Surrounding soft tissue pressure during shoulder arthroscopy. Acta Orthop Belg. 2005; 71(5):521-7. View

10.

Huang R, Wang S, Wang Y, Qin X, Sun Y . Systematic Review of All-Arthroscopic Versus Mini-Open Repair of Rotator Cuff Tears: A Meta-Analysis. Sci Rep. 2016; 6:22857. PMC: 4780011. DOI: 10.1038/srep22857. View

11.

Kelly B, Constantinescu D, Vap A . Arthroscopic and Open or Mini-Open Rotator Cuff Repair Trends and Complication Rates Among American Board of Orthopaedic Surgeons Part II Examinees (2007-2017). Arthroscopy. 2019; 35(11):3019-3024. DOI: 10.1016/j.arthro.2019.06.022. View

12.

Wylie J, Suter T, Potter M, Granger E, Tashjian R . Mental Health Has a Stronger Association with Patient-Reported Shoulder Pain and Function Than Tear Size in Patients with Full-Thickness Rotator Cuff Tears. J Bone Joint Surg Am. 2016; 98(4):251-6. DOI: 10.2106/JBJS.O.00444. View

13.

Ringwalt C, Gugelmann H, Garrettson M, Dasgupta N, Chung A, Proescholdbell S . Differential prescribing of opioid analgesics according to physician specialty for Medicaid patients with chronic noncancer pain diagnoses. Pain Res Manag. 2014; 19(4):179-85. PMC: 4158932. DOI: 10.1155/2014/857952. View

14.

Kim C, Kim J, Kim D . The factors affecting pain pattern after arthroscopic rotator cuff repair. Clin Orthop Surg. 2014; 6(4):392-400. PMC: 4233217. DOI: 10.4055/cios.2014.6.4.392. View

15.

Ravindra A, Barlow J, Jones G, Bishop J . A prospective evaluation of predictors of pain after arthroscopic rotator cuff repair: psychosocial factors have a stronger association than structural factors. J Shoulder Elbow Surg. 2018; 27(10):1824-1829. DOI: 10.1016/j.jse.2018.06.019. View

16.

Frieden T, Houry D . Reducing the Risks of Relief--The CDC Opioid-Prescribing Guideline. N Engl J Med. 2016; 374(16):1501-4. PMC: 4852278. DOI: 10.1056/NEJMp1515917. View

17.

Kidner C, Mayer T, Gatchel R . Higher opioid doses predict poorer functional outcome in patients with chronic disabling occupational musculoskeletal disorders. J Bone Joint Surg Am. 2009; 91(4):919-27. PMC: 2665041. DOI: 10.2106/JBJS.H.00286. View

18.

Manchikanti L, Helm 2nd S, Fellows B, Janata J, Pampati V, Grider J . Opioid epidemic in the United States. Pain Physician. 2012; 15(3 Suppl):ES9-38. View

19.

Svendsen K, Borchgrevink P, Fredheim O, Hamunen K, Mellbye A, Dale O . Choosing the unit of measurement counts: the use of oral morphine equivalents in studies of opioid consumption is a useful addition to defined daily doses. Palliat Med. 2011; 25(7):725-32. DOI: 10.1177/0269216311398300. View

20.

Ciccone 2nd W, Busey T, Weinstein D, Walden D, Elias J . Assessment of pain relief provided by interscalene regional block and infusion pump after arthroscopic shoulder surgery. Arthroscopy. 2008; 24(1):14-9. DOI: 10.1016/j.arthro.2007.07.021. View