A comparison of perioperative pain control in total shoulder arthroplasty: preoperative tramadol is associated with decreased long-term opiate use when compared with traditional opioids

Abstract

BackgroundProlonged opiate use has been associated with adverse patient outcomes and high societal costs. While tramadol, an alternative to traditional opiate pain medications, has evidence-based support for the treatment of knee osteoarthritis, no clear guidance exists in the shoulder arthroplasty literature to guide perioperative prescribing practices. MethodsAll patients from a private insurance database who underwent total or reverse shoulder arthroplasty between 2008 and 2015 were identified. These patients were grouped into 3 mutually exclusive cohorts based on perioperative pain management regimes: those who received (1) traditional opiates only, (2) tramadol only, (3) nonopioids only. These groups were compared for length of stay, prolonged opioid use (defined as opioid use >3 months after surgery), emergency department (ED) visits, 90-day readmissions, and medical complication ResultsFrom 2008 to 2015, 5,797 shoulder arthroplasty patients met inclusion criteria for the study. Of those, 498 (8.6%) received pre- and postoperative tramadol, 2001 (34.5%) traditional opioids, and 3289 (56.7%) nonopioids only. Traditional opioid use was weakly associated with a higher risk of minor medical complications (odds ratio [OR] 1.20, confidence interval [CI] 1.00-1.97, P = .048), ED visits (OR 1.22, CI 19 1.03-1.43, P = .017), and 90-day readmission (OR 1.29, 1.03-1.62, P = .025) compared to nonopioid only users. Additionally, these patients had a markedly higher risk of prolonged narcotic use (OR 6.72, CI 5.89-7.68, P < .001). ConclusionsShoulder arthroplasty who received perioperative tramadol were less likely than those who received traditional opioids to require prolonged opiate pain medication. Given the well-established negative consequences of prolonged opiate use and lack of association between tramadol use and medical complications found in the current study, tramadol should be considered in shoulder arthroplasty candidates. However, tramadol is not without its own risks, and the risk of prolonged postoperative narcotic use is still higher within this population compared to those patients who take no opioids. These results should help inform preoperative pain management plans in patients who are likely to undergo eventual TSA. Level of EvidenceLevel III; Retrospective Cohort Study