Our Summary

This research paper talks about the growing trend of total shoulder replacement surgery being performed as an outpatient procedure. It discusses recent advances in pain management and anesthesia for this type of surgery.

The study suggests that having a standardized procedure, or pathway, for shoulder surgery can improve patient experience. This is because it reduces pain, the need for strong painkillers, and side effects, while also increasing patient satisfaction. A new way to manage pain after surgery involves using a long-lasting nerve block with a drug called dexamethasone. This method provides long-lasting pain relief without causing a sudden return of pain. The study also states that blocking the nerves in the shoulder provides better pain relief than injecting local anesthetic around the joint.

The paper also mentions different techniques for blocking the nerves in the shoulder for surgery, and suggests that a combination of different painkillers should be used. However, it advises against the routine use of a group of drugs known as gabapentinoids.

The paper concludes that anesthesiologists should be leading the charge in creating and implementing these standardized procedures for shoulder replacement surgery performed as an outpatient procedure. These procedures should include selecting the right patients, educating patients, using long-lasting nerve blocks, and using a combination of different painkillers.

FAQs

  1. What are the benefits of adopting pathways for shoulder surgery?
  2. What different approaches to nerve blockade for shoulder surgery are there to consider?
  3. What should be included in multimodal analgesia for shoulder surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about shoulder replacement is to follow the prescribed pain management plan post-surgery, which may include long-acting nerve blockade, acetaminophen, and nonsteroidal anti-inflammatory drugs. It is important to communicate any pain or discomfort to your healthcare provider so they can adjust your pain management regimen accordingly. Additionally, following the recommended physical therapy and rehabilitation plan will help ensure successful recovery and optimal shoulder function.

Suitable For

Patients who are typically recommended for shoulder replacement surgery include those with severe shoulder pain and limited range of motion due to conditions such as osteoarthritis, rheumatoid arthritis, and rotator cuff tears. These patients have tried conservative treatments such as physical therapy, medications, and injections without success. Additionally, patients who have a history of failed previous shoulder surgeries or traumatic injuries may also be candidates for shoulder replacement. It is important for patients to have good overall health and be willing to commit to post-operative rehabilitation in order to achieve successful outcomes from shoulder replacement surgery.

Timeline

Before Shoulder Replacement:

  1. Patient experiences chronic shoulder pain and limited range of motion.
  2. Patient consults with orthopedic surgeon and undergoes thorough evaluation to determine if shoulder replacement is necessary.
  3. Patient undergoes pre-operative tests and evaluations to ensure they are a suitable candidate for surgery.
  4. Patient receives education on the procedure, risks, and post-operative care.

After Shoulder Replacement:

  1. Patient undergoes total shoulder arthroplasty surgery.
  2. Patient is monitored in the recovery room and then discharged home the same day as an ambulatory procedure.
  3. Patient experiences initial post-operative pain, which is managed through long-acting nerve blockade and multimodal analgesia.
  4. Patient begins physical therapy to regain strength and range of motion in the shoulder.
  5. Patient gradually resumes daily activities with guidance from healthcare providers.
  6. Patient experiences improved shoulder function and reduced pain in the long-term.

What to Ask Your Doctor

  1. What are the benefits and risks of shoulder replacement surgery?
  2. What type of anesthesia will be used during the surgery?
  3. How long is the expected recovery time after shoulder replacement surgery?
  4. What type of pain management options will be available after the surgery?
  5. What are the potential complications or side effects of shoulder replacement surgery?
  6. How long will I need to stay in the hospital after the surgery?
  7. What restrictions or limitations will I have after the surgery?
  8. How successful are shoulder replacement surgeries in general?
  9. What is the expected outcome for my specific condition and situation?
  10. Are there any alternative treatments to shoulder replacement surgery that I should consider?

Reference

Authors: Dong X, Wu CL, YaDeau JT. Journal: Curr Opin Anaesthesiol. 2022 Oct 1;35(5):634-640. doi: 10.1097/ACO.0000000000001174. Epub 2022 Aug 9. PMID: 35943122