William Martin, Nicola Doody
University Hospital Wishaw, Wishaw, United Kingdom
Introduction: Our hospital is in the process of establishing a day case total shoulder arthroplasty (TSA) pathway. To inform our postoperative analgesia guideline as part of this pathway, we audited the recent peri-operative analgesia requirements of TSA patients in our health board.
Methods: We undertook a retrospective audit of perioperative analgesia usage for all elective TSA carried out across the 3 hospitals in our health board between 2015-2022. Data was collected from anaesthetic and drug charts and daily oral morphine equivalents (OME) were calculated for each patient. Results were analysed using descriptive statistics.
Results: 65 patients underwent elective TSA between 2015-2022, of which full data could be found for 62 patients. Pre-operative daily analgesia use was common with 95% (n=59) patients taking between one and three different regular analgesics. 21% (n=13) patients were taking strong opiates pre-operatively. 84% (n=52) of patients underwent interscalene nerve block. In total, 11 different types of post-operative opiates were used, the most common being oxycodone and codeine. Postoperative opioid requirements were significant. Median OME peaked on day 1 post-op at 50.5mg/24hrs (IQR 20-72mg) then trended down to 23mg/24hrs by day 4 (IQR 1-39).
Conclusion: Analgesic requirements post TSA are significant, and same day discharge requires prescriptions for strong opioids in the community. Careful opioid stewardship is required to do this safely. We have liaised with our Acute Pain Service and pharmacy teams to develop a comprehensive analgesic guideline for the first post-operative week after TSA.