Cryo-Pneumatic Compression Results in a Significant Decrease in Opioid Consumption After Shoulder Surgery: A Multicenter Randomized Controlled Trial.

Autor:	Khan M; Department of Surgery, McMaster University, Hamilton, Ontario, Canada.; Division of Orthopaedic Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada., Phillips SA; ENCORE Research Inc, Hamilton, Ontario, Canada., Mathew P; Division of Orthopaedic Surgery, Cambridge Memorial Hospital, Cambridge, Ontario, Canada., Venkateswaran V; Division of Orthopaedic Surgery, Halton Healthcare, Georgetown Hospital, Georgetown, Ontario, Canada., Haverstock J; Division of Orthopaedic Surgery, Halton Healthcare, Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada., Dagher D; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada., Yardley D; ENCORE Research Inc, Hamilton, Ontario, Canada., Dick D; ENCORE Research Inc, Hamilton, Ontario, Canada., Bhandari M; Department of Surgery, McMaster University, Hamilton, Ontario, Canada.; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	The American journal of sports medicine [Am J Sports Med] 2024 Sep; Vol. 52 (11), pp. 2860-2865. Date of Electronic Publication: 2024 Aug 21.
DOI:	10.1177/03635465241270138
Abstrakt:	Background: The management of pain after shoulder surgery typically includes the use of cryotherapy and the prescription of opioid analgesics. Much focus has been placed lately on the opioid epidemic, which in part is fueled by excessive prescription of opioid medication. Previous studies have found a combination of cryotherapy and compression effective at reducing analgesic consumption and increasing recovery in patients undergoing knee and spine surgery; however, efficacy in patients undergoing shoulder surgery has not been evaluated. Purpose: To evaluate the effectiveness of a cryo-pneumatic compression device on postoperative shoulder pain, narcotic use, and quality of life when compared with standard care cryotherapy. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: In total, 200 patients older than 18 years scheduled for unilateral shoulder surgery were enrolled. Patients were randomized to receive either postoperative cryo-pneumatic compression or standard care. The intervention group received a cryo-pneumatic device, while the standard care group received the treating surgeon's preferred method of postoperative care, including standard cryotherapy. Narcotic use was evaluated by the number of oral morphine milligram equivalents consumed during the postoperative period, as well as the time to cessation of narcotic use. Patient-reported outcome measures consisted of a numeric rating scale pain score, 36-item Short Form Survey, patient experience assessed using the net promoter score, and adverse events. Outcomes were evaluated at 2, 6, and 12 weeks postoperatively. Results: Patients receiving cryo-pneumatic compression reported a significant decrease in opioid consumption when compared with standard care (oral morphine milligram equivalents median, 56.1 vs 112; P = .02468). A significant increase in self-reported function was seen in the cryo-pneumatic compression group at 2 weeks when compared with standard care (mean, 61.2 vs 54.2; P = .0412). Conclusion: In patients undergoing unilateral shoulder surgery, the use of cryotherapy with pneumatic compression, when compared with standard care, resulted in significantly decreased opioid consumption as well as increased function at 2 weeks. Registration: NCT04185064 (ClinicalTrials.gov identifier). Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Databáze:	MEDLINE
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