Post-operative Pain Assessment in Shoulder Surgery: A Comparison amongst Healthcare Professionals.

Abstract

Background: The multidisciplinary health care model is integral for minimizing postoperative pain following shoulder surgery. Accordingly, the Australian and New Zealand College of Anaesthetists (ANZCA) stipulates that all health professionals involved in postoperative care require an adequate level of understanding in postoperative pain management¹⁴. However, no known peer-reviewed study investigates healthcare professionals' opinions regarding pain following shoulder surgery. This study aimed to assess the perception of patient postoperative pain and subsequent opioid use across medical practitioners, physiotherapists and nurses.

Methods: To address this aim, a 20-part questionnaire was developed to quantify the opinions of healthcare professionals regarding several shoulder surgery outcomes. The questionnaire utilized Visual Analogue Scales (VAS) to allow participants to quantify their subjective assessments of postoperative outcomes across five common types of shoulder procedures. Participants were recruited between 1 January 2021 and 31 December 2021 through contact with representatives from their affiliated organizations. Answers to pain-related questions were subsequently analyzed.

Results: The questionnaire netted 200 responses, of which 132 were complete, and 68 were partial completions. Responses from nursing (35%), allied health (40%) and medical (23%) were included for analysis. Nursing participants assigned higher immediate postoperative pain scores and longer opioid usage following all five types of shoulder surgery, when compared to the values assigned by either physiotherapists or doctors (p<0.05). There is no statistically significant difference in immediate postoperative pain scores, or duration of opioid use assigned between doctors and physiotherapists (p>0.05 for all five types of shoulder procedures).

Conclusion: When examined in the context of current peer-reviewed guidelines, the results of this study showed that all 3 study cohorts overestimated the duration of opioid requirement for all five types of shoulder surgeries assessed in this study - albeit to different degrees. These findings suggest the need for uniform education for doctors, nurses and physiotherapists regarding pain assessment and management immediately following shoulder surgery. While Australian guidelines are readily available online, the awareness of their existence may not be uniformed across all three professions - thus potentially accounting for the differences observed in this study.