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).

中文翻译：

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冷冻气动压缩可显着减少肩部手术后阿片类药物的消耗量：一项多中心随机对照试验


背景：肩部手术后疼痛的治疗通常包括使用冷冻疗法和阿片类镇痛药的处方。最近人们对阿片类药物的流行给予了很多关注，这在一定程度上是由于阿片类药物的过度处方造成的。先前的研究发现，冷冻疗法和压力疗法的结合可以有效减少接受膝盖和脊柱手术的患者的镇痛药消耗并促进康复。然而，尚未评估接受肩部手术的患者的疗效。目的：与标准护理冷冻疗法相比，评估冷冻气动加压装置对术后肩部疼痛、麻醉剂使用和生活质量的有效性。研究设计：随机对照审判;证据级别，2。方法：总共纳入了 200 名 18 岁以上计划接受单侧肩部手术的患者。患者被随机分配接受术后冷冻气压治疗或标准护理。干预组接受冷冻气动装置，而标准护理组接受治疗外科医生首选的术后护理方法，包括标准冷冻疗法。通过术后期间消耗的口服吗啡毫克当量的数量以及停止使用麻醉剂的时间来评估麻醉剂的使用。患者报告的结果测量包括数字评级量表疼痛评分、36 项简短调查、使用净启动子评分评估的患者体验以及不良事件。术后 2、6 和 12 周评估结果。结果：与标准治疗相比，接受冷冻气压治疗的患者阿片类药物消耗量显着减少（口服吗啡毫克当量中位数，56.1 vs 112；P = 0.02468）。与标准护理相比，冷冻气压组在 2 周时自我报告的功能显着增加（平均值为 61.2 vs 54.2；P = .0412）。结论：在接受单侧肩部手术的患者中，使用与标准护理相比，气动压缩冷冻疗法导致阿片类药物消耗量显着减少，并且在 2 周时功能增强。注册：NCT04185064（ClinicalTrials.gov 标识符）。