Preoperative Acetaminophen Decreases Need for Opioids Following Rotator Cuff Repair

DG News

The use of acetaminophen before surgery for rotator cuff repair resulted in better pain control and a decline in opioid use, according to a study published in the Journal of Shoulder and Elbow Surgery.

The prospective, randomised, 3-arm study compared the impact of oxycodone 5 mg every 6 hours as needed plus oral acetaminophen 1,000 mg every 6 hours as needed following surgery (group 1) versus oxycodone 5 mg every 6 hours as needed without any acetaminophen following surgery (group 2) versus oral acetaminophen 1,000 mg every 6 hours for 1 day prior to and after surgery, decreasing to every 8 hours in postoperative days 2 to 5, with patients being allowed to take oxycodone 5 mg every 6 hours if needed following surgery (group 3). Patients in all groups received interscalene blocks with liposomal bupivacaine.

The primary endpoint was the total number of oxycodone tablets patients took in the first week after arthroscopic rotator cuff repair.

“This is looking at the effects of preloading [with acetaminophen] before surgery,” said Joseph Abboud, MD, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania. “This is a medication that can be taken easily, is readily available over the counter, and is not expensive. There is also, generally speaking, no dyspepsia, upset stomach or concern about kidney dysfunction with the use of acetaminophen as opposed to non-steroidal anti-inflammatory drugs.”

All 57 patients, who were aged 30 to 80 years, were instructed not to take any other pain medication. On days 1 to 7 following surgery, patients received a daily survey that included 5 questions about opioid medication use, side effects, how they would rate their pain on a score of 0 to 100, and if they were satisfied with their pain control. These outcomes were recorded daily after surgery for the first week.

Patients in group 3 took significantly fewer oxycodone tablets hoverall compared with the other treatment groups (group 1, 12.97; group 2, 18.88; group 3, 8.06; P = .017). In addition, average medication consumption in group 3 was significantly less than in groups 1 and 2 on day 1 (2.1 vs 3.0 [P = .03] and 2.1 vs 3.2 [P = .02], respectively). In terms of pain control, group 3 patients reported significantly better overall pain control than patients in the other groups (P = .040).

“This was a surprise to us,” said Dr. Abboud, referring to the impact of pre-operative acetaminophen, noting he has changed his practice such that his patients are instructed to take acetaminophen before arthroscopic rotator cuff repair.