Opioid-Free Shoulder Surgery; Tips on Post-Operative Shoulder Surgery Pain Relief

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Dr. Kevin Plancher with Plancher Orthopaedics & Sports Medicine offers tips on post-operative shoulder surgery pain relief with sensitivity towards protecting against potential opioid addiction.

Dr. Kevin Plancher

Patients shouldn’t have to endure severe pain at any time after surgery, and doctors should make sure of that. But the vast majority of the time, keeping patients comfortable after shoulder surgery is doable without resorting to addictive opioid drugs.

With a worsening opioid addiction epidemic in the United States, patients undergoing shoulder surgery should understand what to expect regarding post-operative pain and pain relief options, says orthopaedic surgeon Kevin D. Plancher, MD, founder of Plancher Orthopaedics & Sports Medicine.

Surgery can involve experiencing some pain, but recent advances in surgical techniques – often requiring only tiny incisions with little disruption to bones, muscles and other tissues – offer patients the benefit of less post-operative pain than ever, Dr. Plancher says. Because of this, less-dangerous pain relievers work extremely well at alleviating any discomfort related to shoulder surgery.

“Opioids can and should be avoided whenever possible,” says Dr. Plancher. Categorized as narcotics, opioids are effective at relieving pain. Unfortunately, they are also highly addictive. Up to 36 million people worldwide abuse opioids, which include drugs such as codeine, morphine, fentanyl, hydrocodone and methadone. According to the National Institute on Drug Abuse, about 2.1 million people in the United States suffer from substance abuse disorders linked to prescription opioid use.

“Only about 5% of our post-operative shoulder patients have a need for strong pain relievers such as narcotics,” Dr. Plancher explains, “and if they do, it’s only for the first one or two days after surgery. Doctors today need to be part of the solution and more careful than ever about what they prescribe.”

Surgical techniques reduce post-operative pain
Shoulder surgery is exceedingly common. According to the Agency for Healthcare Research and Quality, more than 53,000 Americans undergo shoulder joint replacement each year, and thousands more have surgery to repair their rotator cuff, remove bone spurs or scar tissue, or stabilize the shoulder after it’s been dislocated.

The expanding use of arthroscopy – which allows an orthopedic surgeon to insert a pencil-thin device using a small lens and lighting into tiny incisions to explore a joint – has increasingly reduced patients’ post-operative discomfort. According to the American Orthopaedic Society for Sports Medicine, more than 1.4 million shoulder arthroscopies are done around the world every year.

Still, some doctors are proactive about treating post-operative pain before surgery even begins, either with oral pain relievers or with injectable drugs. One of those is long-acting bupivacaine, a local nerve block. Bupivacaine can be injected into the shoulder region during surgery, where it will either totally stop pain or cause partial numbness for up to 72 hours afterward.

“Within three days after their procedure, most shoulder surgery patients are barely experiencing any pain or discomfort,” says Dr. Plancher, also a Clinical Professor in Orthopaedics at Albert Einstein College of Medicine in New York. “The nerve blocks such as bupivacaine are a nice addition to our arsenal to help patients transition to pain-free living.”

Safer pain relief available
Pain relievers such as bupivacaine help Dr. Plancher and other orthopedic surgeons smartly veer away from prescribing dangerous opioids, he says. Other, safer pain relief options after shoulder surgery include:

  •     Acetaminophen
  •     NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen or naproxen, which can treat irritation or inflammation surrounding a surgical wound that can trigger pain
  •     Other local anesthetics, which deaden the sensation of pain in the area

“Patients shouldn’t have to endure severe pain at any time after surgery, and doctors should make sure of that,” says Dr. Plancher, who lectures globally on issues related to orthopaedic procedures and sports injury management. “But the vast majority of the time, keeping patients comfortable after shoulder surgery is doable without resorting to addictive opioid drugs. It’s a careful judgment call that every skilled orthopedic surgeon should be qualified to make.”    

Kevin D. Plancher, MD, is a board-certified orthopaedic surgeon and the founder of Plancher Orthopaedics & Sports Medicine.

Plancher Orthopaedics & Sports Medicine is a general orthopaedics and sports medicine practice with offices in New York City and Greenwich, CT. http://www.plancherortho.com

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