Hasan, Laith K.

Purpose To evaluate the efficacy of a multimodal nonopioid analgesic protocol in controlling postoperative pain compared to opioids following a primary arthroscopic rotator cuff repair. Methods Seventy consecutive patients undergoing a primary rotator cuff repair were assessed for eligibility. An observer‐blinded prospective randomized controlled trial was designed in accordance with the Consolidated Standards of Reporting Trials 2010 (CONSORT) statement. The two arms of the study included a multimodal nonopioid pain regimen for the experimental group, and a standard of care narcotics for the control group. The primary outcome was visual analog scale (VAS) pain scores for the first 10 postoperative days. Secondary outcomes included PROMIS‐PI (Patient‐Reported Outcomes Measurement Information System‐Pain Interference) scale, patient satisfaction, and adverse drug events. Results Thirty patients declined to participate or were excluded, and 40 patients were included in the final analysis. A total of 23 patients were in the traditional group, and 17 patients were in the nonopioid group. Control patients on opioid pain management reported a significantly higher VAS pain score on postoperative day 1 (opioid: 5.7 ± 2, nonopioid: 3.7 ± 2.2; P = .011) and postoperative day 4 (opioid: 4.4 ± 2.7, nonopioid: 2.4 ± 2.2; P = .023). No significant difference was seen on any other postoperative day. When mixed measured models were used to control for confounding factors, the nonopioid group demonstrated significantly lower VAS and PROMIS‐PI scores ( P < .01) at every time point. Patients in the traditional analgesia group reported significantly more days with constipation ( P = .003) and days with upset stomach ( P = .020) than those in the nonopioid group. Concussion The present study found that a multimodal nonopioid pain protocol provided equivalent or better pain control compared to traditional opioid analgesics in patients undergoing primary arthroscopic rotator cuff repair. Minimal side effects were noted with some improvement in the multimodal nonopioid pain cohort. All patients reported satisfaction with their pain management. Level of Evidence Level I, prospective randomized controlled trial.

» Orthopaedic surgeons are expected to exercise leadership within a variety of departmental and organizational roles, such as in the context of the clinic, the operating room, private or academic practices, and, more broadly, their respective professional organizations. » Effective leadership can improve patient outcomes and satisfaction, as well as increase team efficacy and gratification. » Exercising insight and understanding as to how and when to employ different leadership styles can help orthopaedic surgeons lead effectively. Additionally, open and effective communication and emotional intelligence play an integral role in effective leadership. » This article reviews some of the current understanding regarding effective leadership in orthopaedic surgery, with a focus on highlighting strategies that are aimed at being a more effective leader.