An Integrated Educational and Multimodal Approach to Achieving an Opioid Free Postoperative Course Following Arthroscopic Rotator Cuff Repair

Abstract Background: In the realm of shoulder surgery, arthroscopic rotator cuff repair (RCR) is one of the most painful procedures and is often associated with higher opioid consumption. The purpose of this study was to evaluate effectiveness of preoperative and postoperative patient education and multimodal pain management to achieve an opioid free postoperative recovery after RCR.    Methods: Sixty patients who underwent RCR were divided in two groups. All patients received an interscalene nerve block and multimodal pain management. The Opioid Intervention Group (OIG) in addition received preoperative education on expectations of pain, non-opioid pain protocols, and alternate therapies to minimize pain as well as customized postoperative instructions. Patients were compared on pain levels, opioid consumption and outcomes scores preoperatively and at 48 hours, 2 weeks, and final follow-up. Patient reported outcomes (PROs) and opioid usage were compared and analyzed using student’s t-tests and logistic regression. Results: At 48 hours, 15% of OIG patients reported use of rescue opioids following surgery compared to 100% of CG patients. Zero percent of OIG patients reported opioid use at 2 weeks compared to 90% of CG patients (p = 0.0196). Patients in both groups showed significant improvements in all outcome scores (p≤0.05). At 6 weeks, functional, Constant, and satisfaction outcome scores were all higher in the OIG (p Conclusions:  Application of patient education tools and innovative multimodal pain management protocols successfully eliminates the need for opioids while maintaining excellent patient satisfaction and outcomes.