Opioid Consumption Following Isolated and Recurrent Shoulder Dislocation and Reduction.

Abstract

Background: Recurrent shoulder dislocations often lead to multiple encounters for reduction and eventual surgical stabilization, both of which involve exposure to opioids and potentially increase the risk of chronic opioid exposure. The purpose of our study was to characterize shoulder instability and compare pre- and post-reduction opioid usage in singular dislocators (SD) and recurrent dislocators (RD).

Methods: This retrospective study was performed at a single academic institution using a prospective database. Patients were included if they were 1) age 18 or older and 2) sustained a shoulder dislocation evaluated within our institution. Electronic medical records were reviewed for patient demographics, emergency department management, and opioid exposure (number and mean morphine equivalent [MME] of opioid prescriptions) both pre- and post-reduction. Cohorts were compared using Wilcoxon rank sum tests for continuous variables and chi-squared or Fischer's exact tests for categorical variables with statistical significance set at p<0.05.

Results: 222 patients were included with mean follow-up 4.4 months (range: 0-70.1 months). 53 (23.8%) patients sustained recurrent dislocations. RDs were significantly younger (median age 26.7 years, IQR: 21.6-44.9) than SDs (55.3 years, IQR: 32.8-70.4; p<0.001) and more likely to have sustained a prior shoulder fracture (n=11 [21.2%] vs. n=3 [1.8%], p<0.001). There were no differences in sex, laterality, or follow-up duration. 18 (34.0%) RDs and 18 (10.7%) SDs underwent surgery including shoulder stabilization procedures, rotator cuff repairs, and fracture fixation (p<0.001). RDs used significantly more opioids at the first follow-up in both the prescribed number of opioids (mean 0.23± 0.5 prescriptions vs. 0.10 ± 0.3, p=0.038) and MME (mean 38.3 ± 96.2 MME vs. 10.7 ± 66.4 MME, p=0.013). This difference is not appreciated from the 30-day postoperative visit onwards. Emergency Room opioid MME prescription and consumption was similar between cohorts.

Conclusion: Patients who sustain recurrent shoulder dislocations exhibit a higher likelihood of consuming significantly greater amounts of opioids following shoulder reduction and ultimately undergoing surgical intervention. The proportion of opioid tolerance and pre-reduction total MME up to 90-days prior to reduction in the recurrent dislocator cohort trended towards significance, but there were no differences observed between rates of opioid usage during ED encounters or at the 30-, 60-, and 90-day timepoints. Patients with chronic shoulder instability should be counseled regarding the increased risk of opioid prescription patterns in the immediate post-reduction period however this risk may decrease over time.