The effects of nonsteroidal anti-inflammatory medications after rotator cuff surgery: a randomized, double-blind, placebo-controlled trial

Tangtiphaiboontana, Jennifer; Figoni, Andrew; Luke, Anthony; Zhang, Alan L.; Benjamin, C.

doi:10.1016/j.jse.2021.05.018

Cited by 23 publications

(16 citation statements)

References 40 publications

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“…Two studies were confirmatory of the integral role of over-the-counter medications in pain control after rotator cuff repair. Tangtiphaiboontana et al 10 demonstrated lower opioid consumption in the first postoperative week and lower early VAS pain scores after cuff repair in patients randomized to receive ibuprofen compared with those randomized to receive a placebo. The rate of tendon retear was not significantly different in the 2 groups.…”

Section: Postoperative Pain Controlmentioning

confidence: 99%

What’s New in Shoulder and Elbow Surgery

Kim

Ricchetti

Hsu

2022

Journal of Bone and Joint Surgery

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Specific emphasis has been placed on higher-quality research (Level-I and II studies) and particularly relevant Level-III studies. Rotator Cuff RepairThe decision to indicate operative repair for degenerative rotator cuff tears is controversial. Kukkonen et al. 1 provided a mean 6.2-year follow-up in 150 patients who were >55 years of age; had small, full-thickness supraspinatus tears; and were randomized to physiotherapy only, acromioplasty and physiotherapy, or repair, acromioplasty, and physiotherapy. The mean change in Constant score (the primary outcome) was similar in the 3 groups, as were changes in the visual analog scale (VAS) pain and satisfaction scores. There was a significant progression of arthritis from baseline to follow-up for the entire cohort without a difference between groups. The authors suggested that operative repair is no better than conservative treatment and does not protect against degeneration of the glenohumeral joint.Long-term follow-up comparing single-row and doublerow repair techniques is uncommon. Lapner et al. 2 reported a 10-year follow-up to a previous 2-year report of a randomized controlled trial (RCT) of 90 patients comparing single-row and double-row repair. At 10 years, the Western Ontario Rotator Cuff Index (WORC) scores were higher in the double-row group. Between 2 and 10 years, significant decreases in the WORC and American Shoulder and Elbow Surgeons (ASES) scores were seen in the single-row repair group but not in the double-row repair group. Only 30 patients had 10-year ultrasound data, which demonstrated similar retear rates between groups: 23% for the single-row repair group compared with 42% for the double-row repair group (p = 0.418). The authors concluded that double-row fixation preserved joint function Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H167).

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Section: Postoperative Pain Controlmentioning

confidence: 99%

What’s New in Shoulder and Elbow Surgery

Kim

Ricchetti

Hsu

2022

Journal of Bone and Joint Surgery

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“…Fifteen studies (71.4%) analyzed the efficacy of oral analgesic medications, including nonsteroidal antiinflammatory drugs (NSAIDs), acetaminophen, and zolpidem, at managing perioperative pain [10][11][12][13][19][20][21]24,26,[28][29][30][31][32][33] . Four studies (19.0%) assessed local pain management modalities, such as transcutaneous electrical nerve stimulation (TENS), cryotherapy, or bandaging 18,22,25,34 .…”

Section: Study Characteristicsmentioning

confidence: 99%

Opioid-Sparing Strategies in Arthroscopic Surgery

et al. 2023

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Background: Opioid overprescription is a problem in orthopaedic surgery. Arthroscopic surgery, given its minimally invasive nature, represents an opportunity to minimize opioid prescription and consumption by using effective pain management adjuncts. Thus, the primary question posed in this study was which noninvasive pain management modalities can effectively manage pain and reduce opioid intake after arthroscopic surgery. Methods: The databases PubMed, MEDLINE, EMBASE, Scopus, and Web of Science were searched on August 10, 2022. Randomized controlled trials (RCTs) evaluating noninvasive pain management strategies in arthroscopy patients were evaluated. Eligible studies were selected through a systematic screening process. Meta-analysis was performed for pain scores and opioid consumption at time points which had sufficient data available. Results: Twenty-one RCTs were included, with a total of 2,148 patients undergoing shoulder, knee, and hip arthroscopy. Meta-analysis comparing nonopioid, oral analgesic regimens, with or without patient education components, with the standard of care or placebo demonstrated no difference in pain scores at 24 hours, 4 to 7 days, or 14 days postoperatively. Nonopioid regimens also resulted in significantly lower opioid consumption in the first 24 hours postoperatively (mean difference, −37.02 mg oral morphine equivalents, 95% confidence interval, −74.01 to −0.03). Transcutaneous electrical nerve stimulation (TENS), cryotherapy, and zolpidem were also found to effectively manage pain and reduce opioid use in a limited number of studies. Conclusions: A range of noninvasive pain management strategies exist to manage pain and reduce opioid use after arthroscopic procedures. The strongest evidence base supports the use of multimodal nonopioid oral analgesics, with some studies incorporating patient education components. Some evidence supports the efficacy of TENS, cryotherapy, and nonbenzodiazepine sleeping aids. Direction from governing bodies is an important next step to incorporate these adjuncts into routine clinical practice to manage pain and reduce the amount of opioids prescribed and consumed after arthroscopic surgery. Level of Evidence: Level II, systematic review and meta-analysis of RCTs. See Instructions for Authors for a complete description of the levels of evidence.

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“…The most recent and perhaps most impactful study of nonselective NSAID use in this population was a randomized, double-blind, placebo-controlled trial of postoperative NSAIDs done in 101 patients undergoing primary arthroscopic rotator cuff repair at a single institution. 25 Patients were prescribed ibuprofen (400 mg every 8 hours for 14 days continuously) or placebo (for the same duration) for postoperative pain control, in addition to opioid medication. Both patients and surgeons were blinded to the medications, and the pills were created to appear identical.…”

Section: Shoulder Arthroscopymentioning

confidence: 99%

Safety and Efficacy of Postoperative Nonsteroidal Anti-inflammatory Drugs in Sports Medicine

Trasolini

Yanke

Verma

et al. 2022

J Am Acad Orthop Surg

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Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for multimodal pain control after surgery. These medications work by selective or nonselective inhibition of cyclooxygenase, which has downstream effects on thromboxanes, prostaglandins, and prostacyclins. Clinical studies have shown beneficial effects for alleviating pain and reducing opioid consumption after surgery. Within hip arthroscopy, there is evidence that postoperative NSAIDs can also reduce the risk of symptomatic heterotopic bone formation. However, preclinical and animal studies have raised concern over the effect of NSAIDs on bone and soft-tissue healing. In addition, selective and nonselective cyclooxygenase 2 inhibitors may have different safety profiles regarding postoperative soft-tissue healing. The purpose of this review was to outline the mechanisms of action, efficacy, and effect on soft-tissue healing of postoperative NSAIDs and to provide evidencebased recommendations for appropriate use.

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The effects of nonsteroidal anti-inflammatory medications after rotator cuff surgery: a randomized, double-blind, placebo-controlled trial

Cited by 23 publications

References 40 publications

What’s New in Shoulder and Elbow Surgery

What’s New in Shoulder and Elbow Surgery

Opioid-Sparing Strategies in Arthroscopic Surgery

Safety and Efficacy of Postoperative Nonsteroidal Anti-inflammatory Drugs in Sports Medicine

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