Application of Pain Quantitative Analysis Device for Assessment of Postoperative Pain after Arthroscopic Rotator Cuff Repair

Purpose : The PainVision™ system was recently developed for quantitative pain assessment. Here, we used this system to evaluate the effect of plexus brachialis block on postoperative pain after arthroscopic rotator cuff repair. Methods : Fifty-five patients who underwent arthroscopic rotator cuff repair were included in this study. First 26 cases received no plexus brachialis block (control group), and the next 29 cases received the plexus brachialis block before surgery (block group). Patients completed the visual analog scale at 4, 8, 16, and 24 hours after surgery, and the intensity of postoperative pain was assessed with PainVision™ at 16 hours. The postoperative use of non-steroidal anti-inflammatory agents was also recorded. Results : The pain intensity at 16 hours after surgery assessed by PainVision™ was significantly lower in the block group than in the control group (block, 252.0 ± 47.8, control, 489.0 ± 89.1, P < 0.05). However, there were no differences in the VAS values at 16 hours between the 2 groups (block, 4.3 ± 0.6, control, 5.7 ± 0.4, P = N.S.). The pain intensity and VAS at 16 hours after surgery were highly correlated (r = 0.59, P = 0.006 in the block group and r = 0.62, P = 0.003 in the control group). The effect size of the assessment by PainVision™ was bigger than that of VAS (r=0.31 in VAS and 0.51 in Pain vision). Conclusion : The PainVision™ system could be useful to evaluate postoperative pain because it enables the quantification and comparison of pain intensity independent of individual pain thresholds.

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Oral Ketorolac as an Adjuvant Agent for Postoperative Pain Control following Arthroscopic Rotator Cuff Repair: A Prospective, Randomized, Controlled Study. (113)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00263 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0026

Author(s):

Lakshmanan Sivasundaram ◽

John Strony ◽

Sunita Mengers ◽

Nikunj Trivedi ◽

Joseph Tanenbaum ◽

...

Keyword(s):

Postoperative Pain ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Arthroscopic Rotator Cuff Repair ◽

Controlled Study ◽

Control Group ◽

Outcome Scores ◽

Vas Scores ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Objectives: Arthroscopic rotator cuff repairs are associated with substantial postoperative pain. Traditionally, oral narcotic agents have been the preferred analgesic postoperatively in orthopaedic surgery. However, these agents are associated with several side effects and a significant potential for abuse. This study evaluates the efficacy of ketorolac, a non-steroidal anti-inflammatory drug with analgesic properties, as an adjunctive agent for postoperative pain control following arthroscopic rotator cuff repair. Methods: Adult patients undergoing an arthroscopic rotator cuff repair were prospectively enrolled. Patients who met inclusion and exclusion criteria were randomized into one of two groups. The control group received our standard of care pain protocol, including oxycodone-acetaminophen 5-325 on discharge. Patients in the ketorolac group additionally received a dose of IV ketorolac intraoperatively and were prescribed a scheduled dose of oral ketorolac (10mg by mouth every six hours for three days) along with omeprazole (20mg by mouth every day for three days) for acid reflux. Visual Analogue Scale (VAS), functional outcome scores, and total narcotic utilization were recorded three times per day for the first five days after surgery. Statistically significant differences in patient demographics and comorbidities between groups were determined initially with univariate analysis. Linear mixed-effect models were then fitted for each outcome variable to evaluate the main effects of treatment group and follow-up times. Results: In our study, 39 patients were included for final analysis; the mean age of the cohort was 55.7±10.6 years and 66.7% of patients were male. There were no differences in preoperative demographics, comorbidities, cuff tear morphology, and functional scores between the two groups. (Table 1) Patients in the Ketorolac group had lower mean VAS scores and opioid utilization at all time points. (Figure 1, 2) On multivariate analysis that controls for confounding variables, patients in the ketorolac group had a mean 9.67 decrease in VAS scores in comparison to the control group, though these results were not statistically or clinically significant (Coefficient estimate= -9.67, 95% CI -25.13-5.79, p=.2202; MCID 13). (Table 3) Patients in the ketorolac group utilized significantly less narcotics, with a mean of 0.7 fewer pills of oxycodone-acetaminophen per time interval in comparison to the control group (Coefficient estimate=-0.70, 95% CI -1.005 -0.389, p<.001). Over the first five days after surgery, patients in the ketorolac group consumed a mean 10.6 fewer narcotic pills, a consumption reduction of 54.6% (19.42 vs. 8.82, p<.001). There was no difference in functional outcome scores at up to six-weeks postoperative between the two groups, (Table 2) as well as no difference in adverse events between the two groups with no reported cases of gastritis or gastrointestinal bleeding. (Table 4). Conclusions: In this prospective, randomized, controlled study, the use of adjunctive intravenous and short-term oral ketorolac substantially reduced narcotic utilization following arthroscopic rotator cuff repair.

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Oral Ketorolac as an Adjuvant Agent for Postoperative Pain Control After Arthroscopic Rotator Cuff Repair: A Prospective, Randomized, Controlled Study

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/jaaos-d-20-01432 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Lakshmanan Sivasundaram ◽

Sunita Mengers ◽

Nikunj N. Trivedi ◽

John Strony ◽

Michael J. Salata ◽

...

Keyword(s):

Postoperative Pain ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Pain Control ◽

Arthroscopic Rotator Cuff Repair ◽

Controlled Study ◽

Postoperative Pain Control ◽

Randomized Controlled ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

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The effectiveness of ramosetron and ondansetron for preventing postoperative nausea and vomiting after arthroscopic rotator cuff repair: a randomized controlled trial

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02060-3 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Sang-Uk Lee ◽

Hyo-Jin Lee ◽

Yang-Soo Kim

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Postoperative Nausea And Vomiting ◽

Complete Response ◽

Arthroscopic Rotator Cuff Repair ◽

Control Group ◽

Antiemetic Drug ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair ◽

Rescue Antiemetic

Abstract Background Arthroscopic rotator cuff repair is a painful procedure, and treatment of emetic events associated with drugs used in the current multimodal pain management remains challenging. This study aimed to evaluate the effectiveness of ramosetron or ondansetron to relieve postoperative nausea and vomiting (PONV) and pain after arthroscopic rotator cuff repair. Methods In total, 122 consecutive patients undergoing arthroscopic rotator cuff repair were randomly allocated into three groups: ramosetron group (n = 39), ondansetron group (n = 43), and control group (n = 40). Then, 0.3 mg of ramosetron or 8 mg of ondansetron was administered intravenously at the end of surgery according to group. All patients received general anesthesia and multimodal pain management protocol including preemptive analgesic medication, fentanyl-based intravenous patient-controlled analgesia, and postoperative analgesic medication. Incidence of emetic events, rescue antiemetic requirements (10 mg of metoclopramide, IV), complete response, pain level, and side effects were recorded in three periods: 0–6, 6–24, and 24–48 h postoperatively. The severity of nausea and pain was evaluated using a visual analog scale. Results The ramosetron group tended to have a lower incidence and severity of nausea during the 6- to 24-h postoperative period and fewer rescue antiemetic drug requirements during the 0- to 48-h period than the control group, showing statistical significance. Additionally, the frequency of complete response of the ramosetron and ondansetron groups was significantly higher than that of the control group. No difference was found among the groups in the pain level except during the 0- to 6-h period. The two groups have a higher complete response during the 6- to 24-h period than the control group. Conclusions Ramosetron use led to a lower incidence, mild severity of nausea, and reduced use of rescue antiemetic drug after arthroscopic rotator cuff repair during the 6- to 24-h postoperative period than the control. Level of evidence Level I, randomized controlled trials, treatment study

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