CRYOCOMPRESSION RESULTS IN A SIGNIFICANT DECREASE IN OPIOID CONSUMPTION FOLLOWING SHOULDER SURGERY: A MULTICENTRE RANDOMIZED CONTROLLED TRIAL

The management of pain following shoulder surgery typically includes the use of cryotherapy and the prescription of opioid analgesics. Much focus has been put lately on the opioid epidemic, which in part is fuelled by excessive prescription of opioid medications. With an increasing number of shoulder surgeries performed, identifying ways to reduce postop opioid consumption is imperative. Previous studies have found a combination of cryotherapy and compression effective at reducing analgesic consumption and increasing recovery in patients undergoing knee and spine surgery, however, efficacy in patients undergoing shoulder surgery has not been evaluated. The aim of this study was to evaluate the effectiveness of a cryocompression device on postop shoulder pain, narcotic use, and quality of life when compared to standard care. A prospective, unblinded, multicentered RCT of 200 patients was performed at 5 hospitals in Canada. Patients over the age of 18 scheduled for unilateral shoulder surgery were enrolled. Patients were randomized to either the cryocompression group or standard care (SC). The intervention group received a cryopneumatic device, the GameReady® GRPro® 2.1 system with a GameReady® ATX® shoulder wrap. The device provides continuous cold and intermittent pneumatic compression therapy to the shoulder joint and surrounding soft tissues. The SC group received the treating surgeon's preferred method of cryotherapy. In both groups patients received a standard shoulder immobilizer, postop medications, and physiotherapy as per their treating surgeon and physiotherapist's standard practices. Narcotic use was evaluated by the number of Oral Morphine Milligram Equivalents (OMMEs) consumed during the postop period, as well as the time to cessation of narcotic use. Patient reported outcome measures (PROMs) consisted of a numeric pain rating scale (NPRS), 36 item Short Form Survey (SF-36), patient experience assessed using the Net Promoter Score, and adverse events (AEs). Patients in the cryocompression group showed a significant decrease in opioid consumption when compared to SC (OMME median 56.1 vs. 112; p=0.02468) (Figure 1). A significant increase in self-reported function was seen in the cryocompression group at 2 weeks when compared to SC (mean 61.2 vs. 54.2; p=0.0412). Time to cessation of opioids was lower in the cryocompression group compared to the SC group, although this measure did not reach statistical significance (median 4 days vs. 6 days; p=0.1543). No significant differences were seen in VAS pain or other SF-36 measures at any timepoints despite significant decrease in opioid consumption in the cryocompression group. In patients undergoing unilateral shoulder surgery, the use of a cryocompression device, when compared to SC, resulted in a significant decreased opioid consumption, as well as increased function at 2 weeks. For any figures or tables, please contact the authors directly.