Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Anesthesiology & Pain Management, Center for Outcomes Research & Evaluation
Shoulder, Maine, Opioid Epidemic, Analgesics, Opioid, Postoperative Period, Epidemics
Introduction: In 2017, there were 47,600 opioid-related drug overdose deaths in the United States. Maine was among the top 10 states with the highest rate overdose deaths involving opioids at 29.9 deaths per 100,000 persons. Opioid use disorder often starts when patients are prescribed opioids for postoperative pain management. Preoperative peripheral nerve blocks alleviate postoperative pain and reduce the amount opioids required for adequate analgesia. While plain bupivacaine has an effect for approximately 12 hours, liposomal bupivacaine’s purported slow-release analgesic effect has the potential to last longer, thereby reducing opioid consumption and possibly the development of addiction in the postoperative patient.
Material and Methods: After Institutional Review Board approval, clinical, demographic, and anthropometric data were retrospectively extracted from the electronic health records of all patients > 18 years of age who underwent arthroscopic shoulder surgery with an interscalene block containing liposomal bupivacaine at Scarborough Surgery Center between January 2019 and June 2019. Visual analogue pain scores and opioid consumption data were collected. Pain scores were collected at 1, 24, 48 and 72 hours postoperatively. 1-hour pain scores were collected from the electronic medical record on the day of surgery. 24, 48- and 72-hour pain data were collected via phone calls. Opioid consumption data was collected through the orthopedic surgeons’ REDCAP database that tracked outpatient opioid prescription pill counts and consumption postoperatively.
Results: Data was collected from 100 patients at Scarborough Surgery Center. Prior to this quality improvement project, the reported rate of opioid consumption at 72 hours postoperatively from outpatient arthroscopic shoulder surgery was approximately 95%. At that time, orthopedic surgeons prescribed 30-84 oxycodone per patient. Following the introduction of liposomal bupivacaine to preoperative interscalene blocks for arthroscopic shoulder surgery, the average patient reported taking 13.8 oxycodone pills (35.8% of the amount prescribed). As a result, the orthopedic surgeons reduced the quantity of oxycodone prescribed from 30-84 pills to 12-25 pills.
Discussion: Between 6 and 10% of patients who receive opioids for acute surgical postoperative pain will continue to use them 6 months to 1 year postoperatively. Large quantity opioid prescriptions increase the risk of ongoing opioid use. In combination with multimodal analgesic strategies, regional anesthesia can minimize the amount of perioperative opioids required by patients for their pain management. Liposomal bupivacaine may provide longer duration of analgesia following its use in interscalene nerve blocks, thereby reducing the amount of postoperative opioids needed. Limitations of our project include no control group outside of historical data on pain scores and opioid use in this population, no blinding or randomization, small sample size, and a large number of anesthesiologists performing the blocks, all of which may affect the efficacy of the block.
Mountjoy, Ryan; Henry, Michael B.; Craig, Wendy Y.; and Richard, Janelle M., "Addressing the Opioid Epidemic in Maine: Liposomal Bupivicaine Reduces Postoperative Opioid Consumption Following Shoulder Surgery" (2020). Costas T. Lambrew Research Retreat 2020. 114.