Natural History of Pain After Shoulder Arthroplasty Conducted With Multimodal Analgesia

Study Overview
=================
Brief Summary
-----------------
This study aims to identify the timeline of pain following total shoulder replacement with the goal of developing data for a subsequent randomized trial. The investigators believe that with using HSS's current protocol, many patients have postoperative pain that is no worse than their preoperative pain. Previous HSS anesthesia protocols for total shoulder arthroplasty patients have not formally followed patients past their hospital discharge, and the investigators believe that some patients do experience moderate to severe subacute postoperative pain. Therefore, this study's primary outcome is to look at the numeric pain scores at 14 days after surgery. Future studies will look at measures of preventing bruising and subsequent pain after shoulder replacement.

Detailed Description
-----------------
This is a pilot study, with the goals of developing data for a subsequent randomized trials describing the pain trajectory after total shoulder arthroplasty given comprehensive multimodal perioperative analgesia gathering preliminary data about which shoulder arthroplasty patients are at high risk for moderate or severe postoperative pain (NRS with movement, POD14, moderate >= 4- 6; Gerbershagen 2011; severe >= 7-10, Krebs 2007) Potential factors include fibromyalgia score, catastrophizing score, anxiety/depression score, gender, preoperative opioid use gathering preliminary data on the potential association between the predictors listed in (c) and NRS pain score with movement on POD 14. estimating incidence and severity of postoperative bruising on POD 14

Official Title
-----------------
Natural History of Pain After Shoulder Arthroplasty Conducted With Multimodal Analgesia

Conditions
-----------------
TSA, Bruise, Pain, Postoperative

Intervention / Treatment
-----------------
* Other: Surveys


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: All patients eligible for the standardized anesthetic for TSA Patients who are capable to provide informed consent and answer questions in English (Study involves questionnaires validated in English) Age 18-80 Exclusion Criteria: Incapable to provide informed consent Contraindications for regional anesthesia (anticoagulation, infection at injection site) Patients undergoing TSA for Trauma or Rheumatoid Arthritis Revision TSA (previous non-TSA surgery is not an exclusion) Conversion of hemiarthroplasty to TSA Planned use of tranexamic acid

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: Surveys|The study is just using validated surveys to assess pain and mood states after surgery|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| NRS Pain Scores | Quantifying patients' pain at a sub-acute time point after surgery | 14 days after surgery for each patient | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| NRS pain with movement and at rest |  | Days 1, 3, 7 and 3 months after surgery | 
| Opioid and NSAID consumption (in past 24 hours) |  | Days 1, 3, 7 and 3 months after surgery | 
| Total number of analgesic pills taken | Other analgesic usage - POD1, POD3, POD7, POD 14, 3 months. (Number of tablets of other analgesics used in past 24 hours, including acetaminophen, NSAIDs, COX2 inhibitors, gabapentin, pregabalin, muscle relaxants) | 1 day, 3 days, 7 days, 14 days and 3 months after surgery | 
| Opioid Related Symptom Distress Scale |  | Day 1 after surgery | 
| Range of Motion | Measure the ability of shoulder movement from 0 to 180 degrees at these follow up visits with the surgeon after surgery. | Day 14 after surgery and 3 months after surgery | 
| Incidence and Severity of Bruising | Surgeon will determine whether bruising occurred and if so, the size and severity of the bruise | Day 14 after surgery and 3 months after surgery | 
| Hospital Anxiety and Depression Scale |  | Day 1 after surgery | 
| PainOUT Questionnaire | Included satisfaction question | Day 1 and 14 after surgery | 
| Pain catastrophizing Scale |  | Day of Surgery | 
| Fibromyalgia Scale |  | Day of Surgery |