American Society of Regional Anesthesia and Pain Medicine November 2017 - 16

Problem-Based Learning Discussion (PBLD): Postoperative Pain
Management in Patients Undergoing Shoulder Arthroscopy
Editor's note: We hope you enjoy this third installment of the problem-based learning discussion feature for the ASRA News. We
contacted some of the readership to provide responses to the case selected for this feature. To keep this feature going, though,
we need your help!
1. Please send deidentified cases you would like to see discussed in this format to the ASRA News at asranewseditor@asra.com.
We will collectively choose the most suitable cases for discussion.
2. Please let us know if we can count on you as a contact to reply to cases and provide your opinion on how you would manage
said case. Please send your name, practice setting, and contact information to asranewseditor@asra.com.
Thanks, and enjoy!

A

74-year-old woman presents for left shoulder
arthroscopy. She suffers from chronic shoulder pain,
obesity (body mass index [BMI] of 45), coronary artery
disease (drug-eluting stent placed 18 months ago), and
previous deep venous thrombosis (DVT). She is also using
2 L of oxygen continuously because of chronic obstructive
pulmonary disease (COPD). Medications include gabapentin
600 mg every 8 hours, oxycodone 20 mg every 4 hours as
needed, metoprolol, simvastatin, aspirin, and clopidogrel,
which has been held for 4 days. Her cardiologist deemed her to
be at a low risk from a cardiac standpoint and stated that no
further cardiac testing is needed before surgery.

Melanie Donnelly, MD
Associate Professor
University of Colorado
Aurora, Colorado

Kristopher Schroeder, MD
Associate Professor
University of Wisconsin
Madison, Wisconsin

Dr Schroeder provided the case, and Dr Donnelly compiled the responses.

Would you prescribe any oral premedications
(eg, gabapentin, opioids) prior to the surgical procedure?
Dr Auyong: Multimodal analgesics are an important part of
managing perioperative pain. For most outpatient shoulder
surgeries, I like to administer acetaminophen and nonsteroidal
anti-inflammatory drugs (NSAIDs) prior to surgery. Typically, I do
not give gabapentin for outpatient surgeries because of the risk
of postoperative sedation. However, in a patient who is already on
gabapentin and oxycodone, I would not hesitate to ensure she took
those medications preoperatively as well.
Dr Maniker: I would ensure that she has taken her gabapentin on
the morning of surgery and would prescribe preoperative 1 g oral
acetaminophen and 200 mg celecoxib.
Dr Harrington: This patient would be given 1,000 mg oral
acetaminophen prior to surgery. She would also be instructed to
take her usual 600 mg gabapentin preoperatively.

16

American Society of Regional Anesthesia and Pain Medicine
2017



Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine November 2017

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