{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T21:15:13Z","timestamp":1781644513416,"version":"3.54.5"},"reference-count":27,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2024,3,6]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Multimodal analgesia has been associated with reduced opioid utilization, opioid-related complications, and improved recovery in various orthopedic surgeries; however, large sample size data is lacking for shoulder surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A retrospective review using the Premier Healthcare Database of patients who underwent inpatient or outpatient (reverse, total, partial) shoulder arthroplasty from 2010 to 2019. Opioid-only analgesia was compared with multimodal analgesia, categorized into 1, 2, or &gt;2 additional analgesic modes, with\/without a nerve block. Multivariable regression models measured associations between multimodal analgesia and opioid charges (in oral morphine equivalents (OME)), cost and length of stay, and opioid-related adverse effects (approximated by naloxone use). We report % change and 95% CIs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 176\u2009225 procedures, 169\u2009679 (75.7% multimodal analgesia use) and 6546 (37.8% multimodal analgesia use) were inpatient and outpatient shoulder arthroplasties, respectively. Among inpatients, multimodal analgesia (&gt;2 modes) without a nerve block (vs opioid-only analgesia) was associated with adjusted reductions in OMEs on postoperative day 1: \u221219.4% (95% CI \u221221.2% to \u221217.6%\/representing unadjusted median OME reductions from 45 to 30 mg). For total hospitalization, this was \u22126.0% (95% CI \u22127.2% to \u22124.9%\/representing unadjusted median OME reductions from 173 to 135 mg). Conversely, for outpatients, this was +13.7% change in OMEs (95% CI +4.4% to +23.0%\/representing unadjusted median OME increases from 110 to 131 mg). In both settings, addition of a nerve block to multimodal analgesia attenuated effects in terms of opioid charges.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Multimodal analgesia is associated with reductions in opioid charges\u2014specifically inpatient setting\u2014but not various other outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2023-104984","type":"journal-article","created":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T13:55:15Z","timestamp":1710770115000},"page":"390-401","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Multimodal pain management and postoperative outcomes in inpatient and outpatient shoulder arthroplasties: a population-based study"],"prefix":"10.1136","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9969-7738","authenticated-orcid":false,"given":"Helen","family":"Liu","sequence":"first","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3114-0263","authenticated-orcid":false,"given":"Haoyan","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Zubizarreta","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Cagle","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1029-2786","authenticated-orcid":false,"given":"Jiabin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7058-5102","authenticated-orcid":false,"given":"Jashvant","family":"Poeran","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA"},{"name":"Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9093-0030","authenticated-orcid":false,"given":"Stavros G","family":"Memtsoudis","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,3,18]]},"reference":[{"key":"2025101112351722000_50.5.390.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2005.02.009"},{"key":"2025101112351722000_50.5.390.2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.K.00580"},{"key":"2025101112351722000_50.5.390.3","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-008-1093-8"},{"key":"2025101112351722000_50.5.390.4","first-page":"1","article-title":"Reverse shoulder arthroplasty in the United States: a comparison of national volume, patient demographics, complications, and surgical indications","volume":"35","author":"Westermann","year":"2015","journal-title":"Iowa Orthop J"},{"key":"2025101112351722000_50.5.390.5","unstructured":"Fisher ES , Bell J-E , Tomek IM , et al . 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