Hello again. So again, I'd like to thank my co-authors at the Rothman Institute and you guys for listening. These are our disclosures. So as we've been hearing throughout the talks, post-operative pain following motoric cardiac arthritis can be severe and difficult to manage. All effective opiate medications are associated with various adverse effects, and as we mentioned yesterday, can lead to chronic use and dependence. Other analgesic modalities are often expensive, such as KyroCuffs, or may be associated with equally adverse effects. The ideal post-operative treatment would be something that is easy to implement, ineffective, safe, and effective. Therapy is inexpensive, it's easily accessible, it's safe, and there's evidence that it can decrease post-operative pain. Studies have shown that relaxation exercises can decrease pain following general surgery, total joint arthroplasty, and spinal arthrodesis. In one study highlighting this, Dr. Shira and his fellow authors randomized patients to relaxation group or a control group. The relaxation group watched a 30-minute video basically detailing techniques for relaxation and guided imagery, and they found that they had significantly less pain at the time of discharge, two weeks post-discharge, and one month post-discharge as well. And so the primary aims of our study were to determine if relaxation exercises can decrease post-operative pain and narcotics use after we take up a pair, and then we wanted to see if relaxation exercises had any effect on shoulder function as well. And so we prospectively randomized patients to one of two groups, the control group or the relaxation group. The control group received our standard oxycodone and acetaminophen tablets, and then KyroCuff use and NSAID use was optional. And then they used a standard post-operative rehab protocol. The relaxation group had the same post-operative protocol as the control group, but also watched a five-minute instructional video during the preoperative period, which detailed how to perform the relaxation breathing techniques. And then they were given a brief pamphlet to take home and review for use during the post-operative period. Our outcomes were assessed using a five-day post-operative journal in which patients recorded V.S. pain scores. And then at two weeks, we collected opiate consumption data and subjective effectiveness of the relaxation exercises from patients as well. The secondary outcomes, which were a shoulder function, were assessed using the ASES score and the SANE score. 151 patients were enrolled in the study in a one-to-one fashion. The average age was 59.5. The average OBMI was 29. And there was a pretty even split between males and females. Of note, there was no difference between groups in these three factors. When we looked at post-operative pain during the first five post-operative days, we found no difference between pain between the control group or the relaxation group. However, when we looked at the two-week post-operative opioid use, we found that the relaxation group consumed significantly less opioid tablets than the control group, with 15 tablets versus 25 tablets. 63% of patients in the relaxation group said that the exercises helped to decrease their pain, and 52% said that they were continuing to use these exercises after the two-weeks post-op. When we looked at shoulder function, we found, again, no difference between groups when measured on the ASES scale. This was also true when we looked at shoulder function based on the shoulder SANES scale. In conclusion, relaxation exercises are inexpensive and easy to implement in the majority of patients. They can decrease post-operative opioid use without changing the reported post-operative pain. The use of relaxation exercises has no effect on post-operative shoulder function. Given their potential benefits, their ease of implementation, we believe that relaxation exercises should be taught or at least discussed with patients during the perioperative period to potentially decrease post-operative opioid use. Thank you for your time.

post-operative pain

opiate medications

relaxation exercises

randomized

adjunct therapy