Problems in self-management of analgesics after outpatient shoulder surgery.

INTRODUCTION: Surgical outpatients are instructed in the use of analgesics post-operatively, but many fail to obtain adequate pain control at home. This study describes how the medication taken related to the prescribed medication and to pain intensity to improve recommendations of drug choice and scheduling. Also, we describe which errors occurred to suggest improvements in patient education and adherence. METHODS: Data were extracted from a study of dexamethasone in day-case arthroscopic shoulder surgery. Patients were recommended paracetamol 1 g four times daily and as needed: ibuprofen 600 mg up to 1,800 mg daily and morphine 10 mg up to 60 mg daily. Patients reported pain intensity and analgesic use until the third post-operative day. RESULTS: A total of 75 patients were available for analysis, and 33 patients (44%) reported an average pain intensity less-than 3 (by numerical rating scale 0-10) during the first three days. Paracetamol was taken as recommended by less-than 50%, and adherence was poorer in patients with higher average pain scores. The maximal daily dose was exceeded for paracetamol (n = 7) and ibuprofen (n = 14) due to too many daily doses or medication of other brand names or strengths than the patients were used to. In total, 32 patients had rescue doses between midnight and 6 a.m. Intolerance was seen for paracetamol (n = 1), ibuprofen (n = 7) and opioid (n = 2). CONCLUSION: Problems in analgesic use after outpatient surgery include undertreatment, poor compliance, overdosage, nightly breakthrough pain and poor tolerance due to side effects. Interventional studies should target these areas. FUNDING: none. TRIAL REGISTRATION: not relevant.

[Lipoma arborescens].

Lipoma arborescens is a rare benign villous proliferation of fatty tissue in joints. It is most often affecting the knee, but it has also been reported in other joints. It may result from chronic irritation but can also be a primary condition. It is diagnosed primarily on MRI combined with the clinical presentation. The surgical treatment of choice is arthroscopic synovectomy. This case report presents a 44-year-old woman with longstanding knee pain due to lipoma arborescens. With increased awareness of this disorder, patients can benefit from proper and timely surgery.

High prevalence of persistent pain 6 months after arthroscopic subacromial decompression and/or acromioclavicular joint resection.

PURPOSE: The aims of this prospective study were to determine the prevalence of pain 6 months after arthroscopic subacromial decompression (ASD) and/or acromioclavicular joint resection (AC resection), to reveal causes of the pain, and to identify risk factors for persistent pain. METHODS: Preoperatively, patients were tested for their endogenous capacity to modulate pain and completed questionnaires concerning psychological vulnerability. Patients with pain 6 months after surgery were examined by an experienced orthopaedic surgeon to reveal any shoulder pathology responsible for the pain. RESULTS: Data from 101 patients were available for analysis 6 months after surgery. Thirty-six patients had persistent pain: 32 underwent examination by the surgeon who identified shoulder pathology in ten patients, but not in the remaining 22 in whom ongoing insurance case, unemployment, and a general tendency to worry were risk factors for persistent pain. CONCLUSION: The prevalence of persistent pain 6 months after ASD and/or AC resection was 35.6% (95% CI 26.1-45.8%) and the proportion of patients with shoulder pathology was 9.9%. An association between ongoing insurance case, unemployment, general tendency to worry (t-STAI), and unexplained persistent pain 6 months after surgery was found.

Acute postoperative pain after arthroscopic rotator cuff surgery: A review of methods of pain assessment.

INTRODUCTION: Pain can be severe during the first days after arthroscopic surgery, and acute pain is an important outcome in clinical trials of surgical technique or anaesthetic strategy. A standardized, validated method of assessing acute postoperative pain would improve the quality of clinical studies, and facilitate systematic reviews and meta-analyses. A step on the way towards this standard is to investigate the methods most commonly used in recent literature. METHODS: PubMed and CINAHL databases were searched, including studies of arthroscopic rotator cuff surgery with a primary pain-related outcome during the first postoperative week, published in English from 2012 to 2017. RESULTS: A total of 47 studies were included, all measuring pain intensity using a pain rating scale. Most frequently used was the visual analogue scale using the anchors "no pain" and "worst pain imaginable", with recordings at 1, 2, 4, 6, 8, 12, and 24 hours postoperatively. A total of 34 studies recorded analgesic consumption, usually as average cumulated consumption in mg. Time to first analgesic request or first pain were recorded in 11 studies, and 4 different starting points were used. DISCUSSION: This review describes the currently most common methods of assessing acute postoperative pain in clinical trials of arthroscopic shoulder surgery involving rotator cuff repair, and the large variety of methods applied. Based on this study and international guidelines, several recommendations on how to measure and report postoperative pain outcomes in future trials are proposed.