Opioid-free shoulder surgery

Opioids (e.g. Vicodin, Percocet, and Oxycodone) are often used to treat pain after orthopedic surgery. However, they can have substantial side effects including nausea, constipation, itching, and unfortunately addiction or even overdose. More and more efforts are being made to limit the need for opioids after shoulder surgery.

Shoulder surgery has a reputation of being very painful. However, we have taken several steps to limit pain after shoulder surgery and have had good success. In fact, in a recent pilot study we performed on pain control after shoulder replacement, 32% of patients did not require any narcotics at all.

The steps we take

• Preoperative education. Studies have shown that understanding the risks of opioids decreases their use. The big one here is understanding that opioids can be addictive after only a few uses. Chronic use is more likely if patients take opioids beyond day 5 after surgery.
• Multimodal approach. We use multiple different non-opioid medications to limit pain. These are given prior to and after surgery. The concept here is that multiple pathways are addressed, and they all work together. This includes neuropathic medications, a nerve block prior to surgery, NSAIDs, Tylenol, and ice.
• Surgical technique. Limiting surgical time by having an efficient technique that limits the invasiveness of the surgery decreases the trauma from the surgery and therefore decreases pain after surgery.
• Rehabilitation. Classically patients were told to do aggressive physical therapy after shoulder surgery. Yet evidence shows that this is not typically beneficial. Aggressive early motion can also be painful. Therefore, we use an individualized approach to therapy after shoulder surgery and lean toward a conservative approach that limits pain and improves healing.

Dr. Patrick Denard has been voted one of the top 20 Shoulder Surgeons in North America, and is the most widely published shoulder specialist in Oregon. Dr. Denard has advanced arthroscopy training and is able to perform the vast majority of shoulder procedures in a minimally invasive fashion, including all types of rotator cuff repairs and instability repair. These techniques allow him to repair tears that some consider "irreparable."