Dr. Vani Sabesan answers ICJR’s questions about multimodal pain management following shoulder procedures, the role of patient education, and how state laws are changing opioid prescribing habits.
ICJR: You’ve done a lot of research on pain management following shoulder procedures, particularly in shoulder arthroplasty and arthroscopic rotator cuff repair. What do surgeons need to know that they may not know now?
Vani J. Sabesan, MD: Education is key. Whether it’s a video, discharge paperwork, or in-person discussions with your patients, the more you communicate with them about the risks of opioids, alternate pain management options, and expectations postoperatively, the better they do. These discussions can significantly impact patient satisfaction, reduce or eliminate opioid use, and facilitate good outcomes.
Surgeons also need to realize that the less they prescribe, the less apt patients are to take all their opioids, which can result in less chronic use and dependence. I usually prescribe anywhere from 8 to 21 opioid pills after shoulder surgery, but only for breakthrough pain. Typically 12 pills – or 3 days’ worth – is enough, but on average, my patients take only 2 to 4 opioid pills after surgery.