If you’ve ever had shoulder surgery, such as a rotator cuff repair, you’ll likely remember the moment the nerve block wore off.
“At that time they’re at their home and the pain gets out of control because they go from a point where they have no pain at all to suddenly having a lot of pain because the freezing is suddenly out,” said Halifax anesthesiologist Dr. Vishal Uppal.
The pain can be so bad that some post-op patients end up in the emergency department. But a small dose of an opioid at the right time might be enough to tame that pain, Uppal said in a recent interview.
He’s leading a research project that will see one set of shoulder surgery patients get a two-milligram dose of hydromorphone six hours after the nerve block is administered. The other patients will get a placebo.
Uppal and his research team — which includesanesthesia resident Dr. Janny Ke and orthopedicsurgeon Dr. Andrew Trenholm — have received funding from the Nova Scotia Health Authority for the two-year trial involving 70 patients undergoing arthroscopic shoulder surgery.
The recovery from shoulder surgeries can be particularly painful because the area contains many nerve fibres, Uppal said, which is why the local nerve block is administered along with general anesthetic for the one- to twohour operation.
Participants in the study will fill in a pain diary and the researchers will check on them to see howthey’re doing with their pain. This information will be put into a database and the results eventually will be published in a study.
Doctors have been grappling with the use of painkillers such as opioids and the associatedissues of addiction and dependence. In this case,the pre-emptive use of a small amount of opioid
before the pain actually starts aims to reduce the amount of drugs the patient takes.
“Our hope is if we time it and give it appropriately, the requirements (for more pain drugs) would be lower rather than higher,” Uppal said.
