Maheshwer Bhargavi, Chen Kallie J, Kuka Casey C, Halkiadakis Penelope, Raji Yazdan, Karns Michael R
Department of Orthopaedics, University Hospital Cleveland Medical Center, Cleveland, OH, USA.
Department of Orthopaedics, University Hospital Cleveland Medical Center, Cleveland, OH, USA.
J Shoulder Elbow Surg. 2025 Aug;34(8):1933-1940. doi: 10.1016/j.jse.2024.12.010. Epub 2025 Jan 23.
Recurrent shoulder dislocations often lead to multiple encounters for reduction and eventual surgical stabilization, both of which involve exposure to opioids and potentially increase the risk of chronic opioid exposure. The purpose of our study was to characterize shoulder instability and compare pre- and postreduction opioid usage in singular dislocators (SDs) and recurrent dislocators (RDs).
This retrospective study was performed at a single academic institution using a prospective database. Patients were included if they were (1) age 18 years or older and (2) sustained a shoulder dislocation evaluated within our institution. Electronic medical records were reviewed for patient demographics, emergency department management, and opioid exposure (number and mean morphine equivalent [MME] of opioid prescriptions) both pre- and postreduction. Cohorts were compared using Wilcoxon rank-sum tests for continuous variables and χ or Fisher exact tests for categorical variables, with statistical significance set at P < .05.
A total of 222 patients were included with mean follow-up 4.4 months (range: 0-70.1 months). Fifty-three patients (23.8%) sustained recurrent dislocations. RDs were significantly younger (median age 26.7 years, interquartile range [IQR]: 21.6-44.9) than SDs (55.3 years, IQR: 32.8-70.4; P < .001) and more likely to have sustained a prior shoulder fracture (n = 11 [21.2%] vs. n = 3 [1.8%], P < .001). There were no differences in sex, laterality, or follow-up duration. Eighteen RDs (34.0%) and 18 SDs (10.7%) underwent surgery, including shoulder stabilization procedures, rotator cuff repairs, and fracture fixation (P < .001). RDs used significantly more opioids at the first follow-up in both the prescribed number of opioids (mean 0.23 ± 0.5 prescriptions vs. 0.10 ± 0.3, P = .038) and MME (mean 38.3 ± 96.2 MME vs. 10.7 ± 66.4 MME, P = .013). This difference is not appreciated from the 30-day postoperative visit onward. Emergency room opioid MME prescription and consumption was similar between cohorts.
Patients who sustain recurrent shoulder dislocations exhibit a higher likelihood of consuming significantly greater amounts of opioids following shoulder reduction and ultimately undergoing surgical intervention. The proportion of opioid tolerance and prereduction total MME up to 90 days prior to reduction in the RD cohort trended toward significance, but there were no differences observed between rates of opioid usage during ED encounters or at the 30-, 60-, and 90-day time points. Patients with chronic shoulder instability should be counseled regarding the increased risk of opioid prescription patterns in the immediate postreduction period; however, this risk may decrease over time.
复发性肩关节脱位常导致多次复位及最终手术稳定治疗，这两者均涉及使用阿片类药物，且可能增加慢性阿片类药物暴露风险。我们研究的目的是描述肩关节不稳的特征，并比较单次脱位者（SDs）和复发性脱位者（RDs）复位前后阿片类药物的使用情况。
本回顾性研究在单一学术机构利用前瞻性数据库进行。纳入患者的条件为：（1）年龄18岁及以上；（2）在本机构接受评估的肩关节脱位患者。回顾电子病历中的患者人口统计学资料、急诊科处理情况以及复位前后的阿片类药物暴露情况（阿片类药物处方数量及平均吗啡当量[MME]）。连续变量采用Wilcoxon秩和检验比较队列，分类变量采用χ²检验或Fisher精确检验比较队列，设定P < 0.05为具有统计学意义。
共纳入222例患者，平均随访4.4个月（范围：0 - 70.1个月）。53例患者（23.8%）发生复发性脱位。RDs患者明显比SDs患者年轻（中位年龄26.7岁，四分位间距[IQR]：21.6 - 44.9）（SDs患者为55.3岁，IQR：32.8 - 70.4；P < 0.001），且更有可能既往有肩关节骨折（n = 11 [21.2%] vs. n = 3 [1.8%]，P < 0.001）。在性别、脱位侧别或随访时间方面无差异。18例RDs患者（34.0%）和18例SDs患者（10.7%）接受了手术，包括肩关节稳定手术、肩袖修复术和骨折固定术（P < 0.001）。在首次随访时，RDs患者使用的阿片类药物在处方数量（平均0.23 ± 0.5张处方 vs. 0.10 ± 0.3张处方，P = 0.038）和MME（平均38.3 ± 96.2 MME vs. 10.7 ± 66.4 MME，P = 0.013）方面均显著更多。从术后30天随访起，这种差异不再明显。队列间急诊室阿片类药物MME处方及用量相似。
发生复发性肩关节脱位的患者在肩关节复位后使用大量阿片类药物及最终接受手术干预的可能性更高。RDs队列中阿片类药物耐受性比例及复位前90天内的总MME有趋于显著的趋势，但在急诊科就诊期间或术后30天、60天和90天时间点的阿片类药物使用率之间未观察到差异。对于慢性肩关节不稳患者，应告知其复位后短期内阿片类药物处方模式风险增加；然而，这种风险可能会随时间降低。
