Department of Anesthesiology, 11238American University of Beirut Medical Center, Beirut, Lebanon.
Department of Orthopedic Surgery, 22957Duke University Medical Center, Durham, NC, USA.
J Orthop Surg (Hong Kong). 2022 Jan-Apr;30(1):10225536221094259. doi: 10.1177/10225536221094259.
This study aims to identify predictors of postoperative pain and opioid consumption after shoulder surgery to help optimize postoperative pain protocols.
Observational cohort study.
One thirty-four patients undergoing arthroscopic shoulder repair were included. Variables related to the patient, surgery and anesthesia were collected and correlated with postoperative pain intensity, analgesic consumption, and functionality up to 1-month post-surgery. We used mixed-effect linear models to estimate the association of gender, interscalene block (ISB), preoperative shoulder pain, non-steroidal anti-inflammatory drugs (NSAIDs) consumption before surgery, and type of surgery with each of the following outcomes: postoperative pain scores, opioid consumption, and functionality. We further analyzed the data for pain scores and opioid consumption per body weight using the multiple linear regression analysis to demonstrate the aforementioned associations specifically at 1 h, 6 h, 12 h, 24 h, 72 h, 1 week and 1 month after surgery.
Omitting the ISB was associated with higher postoperative pain and cumulative opioid consumption over the first 24 h after surgery. Rotator cuff repair and stabilization surgeries were found to be predictive of higher postoperative pain at 24 h, 72 h, and 1 week and lower functionality at 1 week after surgery. Preoperative shoulder pain and NSAIDs consumption were also predictive of postoperative pain and cumulative opioid consumption.
Omitting a single shot ISB is a strong predictor of postoperative pain and opioid consumption in the early postoperative phase, beyond which the type of surgery, particularly rotator cuff repair and stabilization surgery, emerges as the most important predictor of postoperative pain and functionality.
本研究旨在确定肩部手术后疼痛和阿片类药物消耗的预测因素，以帮助优化术后疼痛方案。
观察性队列研究。
共纳入 134 例接受关节镜肩修复术的患者。收集与患者、手术和麻醉相关的变量，并与术后疼痛强度、镇痛药物消耗以及术后 1 个月的功能相关联。我们使用混合效应线性模型来估计性别、肌间沟阻滞（ISB）、术前肩部疼痛、术前非甾体抗炎药（NSAIDs）的使用、手术类型与以下每个结果的关联：术后疼痛评分、阿片类药物消耗和功能。我们进一步使用多元线性回归分析对疼痛评分和按体重计算的阿片类药物消耗数据进行分析，以特别展示上述在术后 1、6、12、24、72、1 周和 1 个月时的关联。
省略 ISB 与术后 24 小时内的术后疼痛和累积阿片类药物消耗增加有关。肩袖修复和稳定手术被发现是术后 24 小时、72 小时和 1 周时术后疼痛以及术后 1 周时功能降低的预测因素。术前肩部疼痛和 NSAIDs 的使用也是术后疼痛和累积阿片类药物消耗的预测因素。
省略单次肌间沟阻滞是术后早期疼痛和阿片类药物消耗的强烈预测因素，除此之外，手术类型，特别是肩袖修复和稳定手术，成为术后疼痛和功能的最重要预测因素。
