Okoroha Kelechi R, Patel Ravi B, Jildeh Toufic R, Sanchez Nathaniel, Sweet Matthew C, Rill Brian K, Kolowich Patricia A, Muh Stephanie J
Orthopedics. 2019 Mar 1;42(2):e247-e252. doi: 10.3928/01477447-20190125-01. Epub 2019 Feb 1.
As anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) become increasingly common, differences between the 2 procedures are of importance. The purpose of this study was to determine differences in acute pain levels between patients undergoing aTSA and rTSA. Sixty patients undergoing aTSA or rTSA were assessed for participation. The primary outcome was postoperative daily visual analog scale scores, which were initially collected for 4 days postoperatively. Secondary outcomes included opioid consumption, length of stay, and complications. Comparisons between the 2 groups were assessed using a multivariable analysis, which controlled for sex, age, body mass index, and type of anesthetic. A total of 57 patients consented and were analyzed. No significant differences were found in postoperative visual analog scale scores in the first 4 days following surgery or at 1 year postoperatively. Patients undergoing aTSA had a higher mean opioid requirement in the first 4 hours postoperatively (1.0±0.7 vs 0.4±0.6 morphine milligram equivalents, P<.01). Forty percent of patients undergoing shoulder arthroplasty were prescribed narcotics within the 3 months prior to surgery. Patients who were prescribed narcotics prior to surgery were more likely to continue to require narcotics at extended time periods postoperatively. Patients undergoing aTSA required more opioid medication in the immediate postoperative period. However, after 4 hours postoperatively, no significant differences in pain scores or opioid consumption were found. These findings suggest that patients undergoing aTSA or rTSA have similar postoperative pain profiles. Patients who are prescribed narcotics before shoulder arthroplasty are at an increased risk for postoperative opioid demand. [Orthopedics. 2019; 42(2):e247-e252.].
随着解剖型全肩关节置换术（aTSA）和反置全肩关节置换术（rTSA）越来越普遍，这两种手术之间的差异变得至关重要。本研究的目的是确定接受aTSA和rTSA的患者在急性疼痛水平上的差异。对60例接受aTSA或rTSA的患者进行了参与评估。主要结局是术后每日视觉模拟量表评分，最初在术后4天收集。次要结局包括阿片类药物消耗量、住院时间和并发症。使用多变量分析评估两组之间的差异，该分析控制了性别、年龄、体重指数和麻醉类型。共有57例患者同意并进行了分析。在术后前4天或术后1年，两组的术后视觉模拟量表评分没有显著差异。接受aTSA的患者在术后前4小时的平均阿片类药物需求量更高（1.0±0.7 vs 0.4±0.6吗啡毫克当量，P<.01）。40%接受肩关节置换术的患者在手术前3个月内被开具了麻醉药品。术前被开具麻醉药品的患者在术后较长时间内更有可能继续需要麻醉药品。接受aTSA的患者在术后即刻需要更多的阿片类药物。然而，术后4小时后，疼痛评分或阿片类药物消耗量没有显著差异。这些发现表明，接受aTSA或rTSA的患者术后疼痛情况相似。肩关节置换术前被开具麻醉药品的患者术后阿片类药物需求风险增加。[《骨科》。2019年；42(2):e247 - e252。]
