Tramadol-based multimodal pain protocols after arthroscopic rotator cuff repair are similarly effective as oxycodone-based protocols with fewer morphine milligram equivalents prescribed and lower risk of refills

Abstract

Background

Tramadol is a synthetic opioid prescribed to control postoperative pain while mitigating the harmful effects of stronger opioids, such as oxycodone. However, it is unknown whether tramadol can serve as an adequate substitute for oxycodone following shoulder surgery. Therefore, the primary purpose of this study was to compare early postoperative pain scores and prescribed narcotic between patients receiving tramadol and oxycodone after arthroscopic rotator cuff repair (ARCR). The secondary purpose was to identify risk factors related to experiencing increased postoperative pain or requiring increased postoperative prescriptions.

Methods

A retrospective cohort study was performed evaluating 58 patients receiving a tramadol-based pain management protocol and 103 patients receiving an oxycodone-based protocol after ARCR. VAS pain scores were obtained preoperatively and at 2 weeks, 6 weeks, and 3 months postoperatively. The change in VAS score from preoperative to 3-month follow-up was calculated. Total milligram morphine equivalent (MMEs) prescribed, number and timing of refills, and the proportion of patients failing the tramadol protocol who required oxycodone were recorded. Multivariate regression analysis was performed to determine risk factors for having higher postoperative pain scores and requiring an increased number of prescriptions.

Results

The average total number of MMEs prescribed for patients who received oxycodone was over 8 times greater than for patients who received tramadol (993 vs. 120 MMEs). Both groups demonstrated improvements in pain scores at all time points. Patients receiving tramadol had a greater change in VAS score from pre to postoperative at all timepoints. Patients who were prescribed oxycodone received a greater number of refills and were 2.7 times more likely to need a refill within 3 months than those receiving tramadol. Only 4 patients (6.9 %) receiving tramadol required oxycodone within 3 months of surgery.

Conclusion

As part of a multimodal protocol, tramadol provides equivalent pain relief after ARCR compared to oxycodone while requiring fewer MMEs. Patients prescribed oxycodone exhibit a smaller magnitude of improvement in VAS pain and require more refills than those prescribed tramadol. Our findings can be used to improve opioid prescription practices to reduce dependency and over prescription of narcotics.