2023 ISAKOS Biennial Congress ePoster
Non-Selective NSAIDs Provide Good Clinical Outcomes and Do Not Increase Retear rates post-arthroscopic rotator cuff repair: A systematic review and meta-analysis
Shawn Js Seah, MBBS, Singapore, Singapore SINGAPORE
Mark H.X. Yeo, MBBS, Singapore, Singapore SINGAPORE
Cheryl Gatot, MD, Singapore SINGAPORE
Denny T. T. Lie, MBBS, FRCS, FAMS, Singapore SINGAPORE
Singapore General Hospital, Singapore, Singapore, SINGAPORE
FDA Status Not Applicable
Summary
This systematic review and meta-analysis found that incorporating non-selective NSAIDs in post-arthroscopic rotator cuff repair pain management protocol is safe and effective and does not increase retear rates.
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Abstract
Background
Arthroscopic rotator cuff repairs are known to be associated with substantial pain and post-operative pain management is critical in overall patients' outcomes. Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used oral medications and can reduce opioid usage. However, controversies arise due to it postulated effect on postoperative tendon healing. Even though there are studies evaluating the use of multimodal pain management protocols, the evidence of safety and efficacy of NSAIDs remains unclear. Therefore, this study aims to investigate the effect of NSAIDs on retear rates and clinical outcomes.
Methods
A systematic search of four databases (PubMed, EMBASE, Scopus and Cochrane Library) was conducted, identifying studies that compared cohorts with post-rotator cuff repair NSAIDs use versus Control groups without NSAID use. Meta-analysis was conducted for Retear rate as well as pain and functional outcomes (Visual analogue scale (VAS) and American Shoulder and Elbow Surgeons Shoulder (ASES) score). Subgroup analysis was conducted for retear rates to determine the overall treatment effect of selective COX-2 inhibitors.
Results
Six studies were included in the meta-analysis. The total baseline cohort size was 916, with 443 (48.3%) patients in the NSAID group and 473 (51.6%) patients in the Control group. There were no significant differences in the baseline characteristics between the two groups. Meta-analysis showed that there were no significant differences between Retear rates (p=0.71), early and late post-operative VAS score (p=0.10 and p=0.10 respectively) and latest ASES score (p=0.31). However, subgroup analysis of retear rates revealed a statistically significant difference between the subgroup including selective COX-2 inhibitor versus non-selective COX inhibitor (p<0.01).
Conclusion
Non-selective NSAIDs use in post-arthroscopic rotator cuff repair pain relief is safe and can potentially reduce opioid consumption without increasing retear rates. Selective COX-2 inhibitors like Celecoxib should not be used as they might lead to higher retear rates than non-selective NSAIDs. However, more comparative studies on COX-2 inhibitors are required to verify this.