Total shoulder arthroplasty - how to manage pain after surgery?

By: [email protected] (Frederick A. Matsen III, M.D.)

Posted on: December 11, 2020

Category: Total Shoulder Arthroplasty , Celebrex , Pain Management

Total shoulder arthroplasty - how to manage pain after surgery?

Celecoxib significantly reduces opioid use after shoulder arthroplasty

These authors evaluated the effect of celecoxib on pain control and opioid use after shoulder surgery.

Patients scheduled for either total shoulder replacement (group 1) or rotator cuff repair (group 2) were candidates for the study. Consenting patients were randomized to receive either placebo or celecoxib 1 hour prior to the procedure and for 3 weeks postoperatively. 

Patients received their study medication or placebo at the time of discharge: either celecoxib, 200 mg, or placebo twice daily for 3 weeks. An opioid prescription was given to be used in conjunction with the study medication and included oxycodone-acetaminophen, hydrocodone-acetaminophen, codeine, or tramadol. Patients were instructed to count and record remaining opioids, as well as any opioid refills received. Opioid consumption was calculated as the morphine-equivalent dose (MED) to standardize opioid use among patients.

78 patients were enrolled for arthroplasty (group 1, with 39 receiving celecoxib and 39 receiving placebo) and 79 were enrolled for rotator cuff repair (group 2, with 40 receiving celecoxib and 39 receiving placebo). 

Arthroplasty patients prescribed celecoxib took fewer morphine-equivalent doses than controls at 3 weeks  (–197.7) and at 6 weeks ( –270).

No statistically significant differences in opioid consumption were found between study arms in the cuff repair group, at either 3 or 6 weeks. 

Preoperative opioid use was statistically associated with higher levels of opioid use in the arthroplasty group.

The authors point out that potentially serious complications from COX-2 inhibitors can occur, such as cardiovascular issues, thrombosis, and stroke. None of these adverse events were observed in their patient population; however, their population was carefully selected to exclude patients with a history of stroke or cardiovascular events.

They also point out that COX-2 inhibitors may be associated with compromised tendon-to-bone healing. 

Comment: This is an interesting randomized controlled trial showing the effectiveness of celecoxib in reducing narcotic use in selected shoulder arthroplasty patients.  

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Tags: Total Shoulder Arthroplasty , Celebrex , Pain Management

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