A clinical pathway for total shoulder arthroplasty-a pilot study

Area of Science:

• Orthopedic Surgery
• Pain Management
• Anesthesiology

Background:

• Effective pain management is crucial for rehabilitation and outcomes following total shoulder arthroplasty (TSA).
• A multimodal analgesia approach may optimize postoperative care.

Purpose of the Study:

• To evaluate a specific multimodal analgesia clinical pathway for patients undergoing TSA.
• To assess pain levels, motor function, and opioid consumption.

Main Methods:

• Prospective observational study involving ten TSA patients.
• Interscalene nerve block with general anesthesia, followed by scheduled non-opioids and on-demand opioids.
• Twice-daily assessments of pain, muscle strength, and sensory function.

Main Results:

• Nerve block provided an average of 18 hours of analgesia.
• Patients reported low pain scores, especially in the PACU, with moderate increases on postoperative day 1.
• Half of the patients used patient-controlled analgesia minimally; motor strength recovery was observed by postoperative day 1.

Conclusions:

• The multimodal analgesic protocol was well-tolerated and effective in managing pain after TSA.
• Low pain scores and reduced opioid consumption were noted, with some recovery of muscle strength.
• Future research should aim to prolong nerve block duration and further minimize motor block and opioid requirements.