Efficacy of acetaminophen versus ibuprofen for the management of rotator cuff-related shoulder pain: Randomized open-label study

Long-Term Preoperative Nonsteroidal Anti-inflammatory Drug Use Does Not Impact Revision Rate After Repair of Rotator Cuff, Achilles, Distal Biceps, or Quadriceps Tendon

Purpose

To determine whether long-term preoperative nonsteroidal anti-inflammatory drug (NSAID) use affected the revision rates after primary tendon repair for the following common sports medicine surgical procedures: rotator cuff repair (RCR), Achilles tendon repair (ATR), distal biceps repair (DBR), or quadriceps tendon repair (QTR).

Methods

A retrospective comparative study using a national insurance database was performed. Patients who underwent major tendon repair, including RCR, ATR, DBR, or QTR, with at least 2-year follow-up were identified. Those who had a diagnosis of long-term NSAID use prior to the index operation were identified and matched 1:4 to controls without NSAID use based on age, sex, specific tendon repaired, and Elixhauser Comorbidity Index. The revision repair rates of the 2 groups were compared.

Results

A total of 36,068 patients underwent major tendon repair. Of these, 7,246 (20%) met the long-term NSAID use criteria prior to tendon repair (NSAID users). After RCR, 3.2% of NSAID users (n = 190) and 2.6% of controls (n = 617) underwent revision surgery within 2 years (odds ratio [OR], 1.15; 95% confidence interval [CI], 0.97-1.36; P = .10). After ATR, NSAID users had a revision rate of 3.9% (n = 24) versus 2.5% (n = 62) in the control cohort (OR, 1.47; 95% CI, 0.89-2.38; P = .12). After DBR, both NSAID users and controls had fewer than 11 revision cases (OR, 1.54; 95% CI, 0.49-4.16; P = .42). After QTR, the revision rate was 5.9% (n = 30) for NSAID users compared with 4.8% (n = 95) for the control group (OR, 1.22; 95% CI, 0.77-1.86; P = .38). None of the observed differences in revision rates between NSAID users and controls were significant.

Conclusions

Patients with a diagnosis of and coding for long-term preoperative NSAID use do not have greater revision rates within 2 years of primary tendon repair than patients without this diagnosis.

Level of Evidence

Level III, retrospective case-control study.

[Open observational study with a retrospective analysis of the efficacy and tolerability of aceclofenac in patients with acute non-specific low back pain]

OBJECTIVE

To analyze the efficacy and tolerability of aceclofenac in the treatment of patients with acute non-specific musculoskeletal pain in the lower back (ANBP) compared with other NSAIDs (dexketoprofen, nimesulide and lornoxicam), as well as to assess the impact of NSAIDs therapy on the relative risk of recurrence and chronicity of this pathology.

MATERIAL AND METHODS

The study involved 80 patients (47 women and 33 men), average age 52.6 [47.2; 56.9] years, divided into 4 groups: group 1 (n=20) aceclofenac 200 mg/day 10 days; group 2 (n=20) dexketoprofen 50 mg/day 5 days; group 3 (n=20) nimesulide 200 mg/day 10 days; group 4 (n=20) lornoxicam 16 mg/day 10 days. All patients received basic treatment, including an oral centrally acting muscle relaxant for 14 days and B vitamins for 1 month. Within the framework of 3 visits (start of treatment, 14 days and 1 month) the VAS pain scale, the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), the Back Pain Functional Scale (BPFS), the SF-36 «The Medical Outcomes Study 36-Item Short-Form Health Survey», the Global Rating of Change Scale (GROC), adverse drug reactions were analyzed. The probability of relapse and chronicity of pain syndrome after NSAID treatment was retrospectively assessed in 251 patients: aceclofenac (n=54), dexketoprofen (n=62), nimesulide (n=74) and lornoxicam (n=61). The duration of the observation period was 20.2±3.5 months.

RESULTS

In visits 2 and 3 there was a significant relief of pain (VAS) and the neuropathic component of pain (LANSS) compared to the initial parameters without significant differences between the groups. At visit 2 and visit 3 in group 4 the BPFS and SF-36 values were significantly lower than in the other groups. In group 2 at visit 2 the SF-36 was significantly lower than in groups 1 and 2. The total number of adverse events was 41.3%. A higher frequency of gastrointestinal adverse events was observed in group 2, and cardiovascular - in group 4 compared to the group 1. At the end of the study, a significantly larger proportion of patients in all groups of patients assessed the improvement from the therapy as «significant», without any differences between the groups. The relative risk of low back pain chronicity was significantly higher with nimesulide (OR=4.378 (0.95% CI 1.022-18.765)) and lornoxicam (OR=4.426 (0.95% CI (1.014-19.316)), and recurrence was higher with dexketoprofen (OR=2.743 (0.95% CI 1.076 - 6.994)) compared to aceclofenac.

CONCLUSIONS

The use of NSAIDs for low back pain is effective and safe. Aceclofenac and nimesulide are superior to dexketoprofen and lornoxicam in terms of functional activity associated with low back pain and health-related quality of life. Aceclofenac demonstrated the most favorable safety profile and a lower risk of chronicity (compared to nimesulide and lornoxicam) and recurrence (compared to dexketoprofen) of low back pain.

The Safety Assessment of Irrigation Fluid Management for Shoulder Arthroscopy and Its Effect on Postoperative Efficacy

OBJECTIVE

Fluid extravasation is a potentially dangerous complication associated with shoulder arthroscopy. Most relevant studies have involved respiratory system, while the primary purpose was to reveal the effects of the fluid extravasation on cardiovascular system and postoperative function.

METHODS

The clinical data of 92 patients was retrospective analyzed, in which 84 cases with rotator cuff injury, three cases with shoulder instability, three cases with fractures of the greater tuberosity of the humerus, and two cases with frozen shoulder. All the patients were undergoing shoulder arthroscopy. The relationship between the basic information of the patients and cardiac index (CI) or pulse pressure variation (PPV) were evaluated by linear regression analysis. The change of CI or PPV at different states were evaluated by the one-way analysis of variance. The liquid retention (TR) and postoperative clinical outcomes was analyzed using linear regression.

RESULTS

The preoperative CI was affected by anesthesia status and body position, while PPV was not affected. Multivariate mixed-effects model analysis of CI found that there was a statistically significant difference in groups of older than 55 years old and those with obesity (BMI > 24). After the operation, the retention of irrigation fluid significantly influenced the circumference of the deltoid (P < 0.001 (95%CI: [0.30, 1.00])), but not on the circumference of the deltoid, neck, and arm. The multivariate analysis of the American Shoulder and Elbow Surgery (ASES) scores at 3 and 6 months after surgery showed that the fluid retention volume was correlated with the ASES score at 3 months after surgery, especially when the retention volume was greater than 2 L (P = 0.001 (95%). %CI: [-12.49, -3.22]).

CONCLUSION

The retention of irrigation fluid after shoulder arthroscopic surgery causes swelling of local limbs, and has an effect on peripheral blood vessels, which is mainly reflected in its influence on PPV and the postoperative function. Therefore, surgeons need to improve their surgical technique, shorten the operation time and reduce fluid retention.

Validity and reliability of the Arabic quick disabilities of the arm, Shoulder and Hand (QuickDASH-Arabic)

BACKGROUND

The QuickDASH is a commonly used upper extremity region-specific outcome measure assessing activity limitation and symptoms. The Arabic version of QuickDASH is available in the official outcome measure website, but no prior studies have examined its psychometric properties.

OBJECTIVE

To examine the psychometric properties of the Arabic QuickDASH in patients with upper extremity musculoskeletal disorders.

METHODS

Participants with upper extremity musculoskeletal disorders were recruited (N = 109) using convenience sampling and completed the Arabic QuickDASH, Numeric Pain Rating Scale, Global Assessment of Function, and RAND 36-item Health Survey in two testing sessions (2-7 days apart). The Arabic QuickDASH structural validity, internal consistency, floor and ceiling effect, test-retest reliability, measurement error, and construct validity were examined.

RESULTS

Exploratory factor analysis indicated a one factor underlying the Arabic QuickDASH. The Arabic QuickDASH had Cronbach's alpha of 0.90 and ICC_2.1 of 0.91 indicating excellent internal consistency and test-retest reliability. None of the participant reached the minimum or the maximum score. The scale's standard error of measurement and minimal detectable change were 7.0 and 16.3. Five out of the six construct validity predefined hypotheses were supported by the results.

CONCLUSION

The Arabic QuickDASH is a unidimensional scale with excellent internal consistency, test-retest reliability and acceptable measurement error. The Arabic Quick DASH is a valid and reliable outcome measure that can be used in Arabic speaking countries with Arabic patients suffering from various upper extremity activity limitations and symptoms.