A nonopioid multimodal pain protocol achieves equivalent pain control after total shoulder arthroplasty: a randomized controlled trial.
Hardy Evans, Joshua P Castle, Johnny Kasto et al.
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In 30 seconds
This prospective, single-blinded randomized controlled trial compared postoperative nonopioid multimodal analgesia with an opioid-containing regimen after primary anatomic or reverse total shoulder arthroplasty. Among 78 patients, pain scores at 10 days were comparable between groups, while opioid consumption was lower with the nonopioid protocol: 0.4 ± 1.35 versus 3.7 ± 5.07 morphine milligram equivalents (P < .001). Side effects did not differ significantly. The findings indicate that, in this selected surgical population, the nonopioid regimen achieved pain relief comparable to the opioid-based regimen while reducing opioid use.
Key findings
- At 10 days, mean visual analog scale pain scores were 2.4 ± 1.7 with multimodal analgesia and 2.3 ± 1.6 with the opioid regimen (P = .52).
- Median Pain Interference scores were 61.5 (interquartile range 58.5-67.0) and 62.0 (interquartile range 56.5-64.0), respectively (P = .90).
- Opioid consumption was 0.4 ± 1.35 morphine milligram equivalents in the multimodal group versus 3.7 ± 5.07 in the opioid group (P < .001).
- Side effects did not differ significantly between treatment groups.
Why it matters
Postoperative pain management must balance adequate relief with limiting opioid exposure. This trial suggests that a multimodal nonopioid protocol can provide comparable short-term pain outcomes after primary shoulder arthroplasty while reducing opioid consumption. The results add randomized evidence relevant to opioid-sparing approaches, although they apply to the study’s selected patients and measured postoperative period.
What to keep in mind
Follow-up and reported outcomes covered only the first 10 postoperative days; patients with recent opioid use, revision surgery, or fracture surgery were excluded.