The Effect of Text Messaging on Medication Adherence After Outpatient Knee Arthroscopy: A Randomized Controlled Trial.

PURPOSE: The purpose of this project was to examine if text message reminders can increase postoperative adherence to treatment with acetaminophen among outpatients undergoing arthroscopic knee surgery. DESIGN: A nonblinded randomized control trial. METHODS: In this study, 187 patients were randomized to either an intervention group (text message reminders) or a control group (no text message reminders). On the fourth postoperative day, all patients received an electronic questionnaire concerning (1) adherence to treatment with acetaminophen (main outcome), (2) pain intensity, and (3) unscheduled health care contacts. FINDINGS: Data were available from 134 patients (intervention group, n = 70; control group, n = 64). No significant differences between groups were found regarding the median number of missed acetaminophen doses (1 vs 2.5; P = .06), pain intensity at rest and during walking, or the number of unscheduled health care contacts (7 vs 4; P = .35). CONCLUSIONS: A nonsignificant trend toward an increased medication adherence of acetaminophen was found.

Persistent pain is common 1-2 years after shoulder replacement.

BACKGROUND AND PURPOSE: Persistent postsurgical pain is a well-recognized problem after various types of surgery such as amputation and thoracotomy. The prevalence of persistent pain, and the extent to which it involves neuropathic pain, is highly dependent on the type of surgery. We investigated the prevalence of, characteristics of, and risk factors for persistent pain 1-2 years after shoulder replacement. PATIENTS AND METHODS: A questionnaire was sent to patients who underwent primary shoulder replacement between April 2011 and April 2012, and whose data were recorded in the Danish Shoulder Arthroplasty Register. Patients who had undergone reoperation or bilateral replacements were excluded. Persistent pain was defined as constant or daily pain within the last month, which interfered much or very much with daily activities. Multivariate logistic regression was used to assess risk factors. RESULTS: 538 patients were available for analysis. The prevalence of persistent pain was 22% (CI: 18-25), and the prevalence of presumed neuropathic pain was 13% (CI: 10-16). Persistent pain was more frequent in fracture patients (29%) than in osteoarthritis patients (16%), while the prevalence of neuropathic pain was similar. Severe pain during the first postoperative week increased the risk of persistent pain. Risk also increased with hemiprosthesis (as compared to total prosthesis) in osteoarthritis patients, and with previous osteosynthesis and pain elsewhere in fracture patients. INTERPRETATION: Persistent pain after shoulder replacement is a daily burden for many patients. Further studies should address patient and prosthesis selection, postoperative pain management, and follow-up of these patients.

Local infiltration analgesia versus continuous interscalene brachial plexus block for shoulder replacement pain: a randomized clinical trial.

BACKGROUND: Shoulder replacement involves significant post-operative pain, which is often managed by continuous interscalene brachial plexus block. Catheter displacement and complications limit the beneficial effect of the block. Local infiltration analgesia (LIA) has provided good results in knee replacement. We aimed to assess the effectiveness of LIA for pain after shoulder replacement. METHODS: Patients scheduled for primary shoulder replacement under general anaesthesia were randomized to receive either local infiltration analgesia (LIA) (150 ml ropivacaine 0.2 % with epinephrine intra-operatively) or interscalene brachial plexus catheter (ISC) (ropivacaine 0.75 %, 7 ml bolus followed by 48-h 5 ml/h infusion). The primary outcome was opioid consumption during the first 24 post-operative hours. Secondary outcomes were pain ratings, supplementary analgesics, and side effects for 3 days, and complications until 3 months after surgery. RESULTS: Data were analysed for 61 patients (LIA 30, ISC 31). Twenty-four-hour opioid consumption was higher in the LIA group compared with the ISC group: median (IQR) 95 mg (70-150 mg) versus 40 mg (8-76 mg) (P = 0.0001). No significant difference in opioid consumption was found between groups during the following 3 days. The LIA group had higher pain scores at 0, 2, 4, and 8 h. Two patients in the ISC group had long-lasting complications. CONCLUSIONS: The LIA technique cannot be recommended for shoulder replacement unless substantially modified. Occurrence of inadequate analgesia and complications following interscalene brachial plexus block prompt further studies into pain management after shoulder replacement.

The Danish version of the Western Ontario Rotator Cuff Index.

INTRODUCTION: The aim of this study was to cross-culturally adapt the Western Ontario Rotator Cuff Index (WORC) into a Danish version (D-WORC) and evaluate its validity, reliability and responsiveness in patients undergoing surgery for arthroscopic subacromial decompression or rotator cuff repair. METHODS: The original WORC version was cross-culturally adapted into Danish and, the validity, test-retest reliability, responsiveness construct validity, internal consistency, interclass correlation coefficient (ICC), limits of agreement (LOA) and an anchor minimal important change (MIC) were assessed using the Disabilities of Arm, Shoulder and Hand (DASH), the Oxford Shoulder Score (OSS), the Short Form-36 and the global rating scale. RESULTS: The cross-cultural adaption was successful. The correlation was high between the D-WORC and DASH (Pearson's correlation coefficient (PCC) = 0.71; 95% confidence interval (CI): 0.60-0.79) and moderate between the D-WORC and the OSS (PCC = 0.67; 95% CI: 0.55-0.76). Reliability analysis showed an ICC of 0.80 (95% CI: 0.69-0.87) and an internal consistency of 0.94 (95% CI: 0.92-0.95). The test-retest mean difference was 76.4 (± standard deviation = 201.40). LOA ranged from -318.3 (95% CI: -387.8--248.9) to 471.2 (95% CI: 401.7-540.6) for the total WORC score. The MIC was -211 in the total score. CONCLUSIONS: The D-WORC is a valid, reliable and responsive questionnaire that can be used in Danish populations. FUNDING: Lone Dragnes Brix: Familien Hede Nielsens Fond, Gurli og Hans Engell Friis' Fond, Aase og Ejnar Danielsens Fond, Knud og Edith Eriksons Mindefond, Region Midtjyllands Sundhedsvidenskabelige Forskningsfond. TRIAL REGISTRATION: Danish Data Protection Agency: 1-16-02-653-15.