These are our disclosures. So as we know, post-operative pain following both takeups of a parent can be significant and difficult to manage. And therefore, pain management during this period should be a key factor of patient care. Opioid medications continue to be the mainstay treatment for post-operative pain, despite their association with adverse effects and potential for lethal overdose. And unfortunately, many patients continue to use opioid pain medications beyond the initial post-operative period, which can increase their risk for chronic use and abuse. The increase in opioid dependence and the opioid epidemic have increased interest in methods to decrease post-operative opioid consumption. This spurred Dr. Austin and his co-authors to see if educating patients during the pre-operative period as to opioid risk and appropriate use can decrease the rate of post-operative use. Patients were randomized to an education or control group. The education group was shown to have decreased post-operative consumption at six weeks and three months. And they were also shown to discontinue their use at an earlier rate. However, it's unknown if this education leads to decreased long-term opioid use. And so the purpose of our study was to determine what the incidence of long-term opioid use was and then to see if pre-operative education decreased this incidence. Then we also wanted to see if pre-operative opioid use also had an effect on long-term use of opioid medications. And so we used the same initial study cohort from the previous study. We included adult patients that were undergoing multi-cuff repair. We excluded patients that had evidence of arthritis and patients with irreparable or partially repairable tears. Patients were randomized to a control group or an education group. The control group received our standard post-op pain regimen at that time, which was an interscaling nerve block, 50-oxycodone CMF in tablets, and then the option for refill tablets. The education group had the same post-op pain protocol, but also received a two-minute pre-operative educational video, which detailed appropriate pain medication use, as well as associated adverse effects. And then they were given a brief pamphlet to take home, which detailed this information as well. In terms of our outcomes, we searched the New Jersey and Pennsylvania state prescription drug monitoring programs. And we converted all opiate scripts to morphine equivalents to standardize the outcomes. Long-term use was defined as two or more opiate prescriptions beyond the initial prescription. We also contacted patients for two-year post-operative shoulder outcomes. This was conducted using the pain BS score and the SANE score as well. And so what we found was that 31% of patients became long-term users, 40% of the control group versus 23% of the educated group. And this difference was a significant difference. When we looked at shoulder function, we found that there was no difference between groups when measured on the SANE score or measured on the pain BS score. When we looked at patients that used opiates during the preoperative period versus those that did not, we found that over half of the patients that used the opiate medications during the preoperative period became long-term users compared to only 4% of patients that did not use them during the preoperative period. And again, this was a significant difference. Interestingly, when we looked at shoulder function, we also found that patients that used preoperative opioids had worse shoulder function when measured on the SANE score and also worse shoulder pain when measured on the pain BS score. In conclusion, almost one third of patients chronically used opiate medications after rotator cuff arm repair. Preoperative opioid medication did decrease the rate of long-term use. And preoperative opioid use was associated with long-term opioid use and worse shoulder function two years after ARCR. Given these results, we recommend that all patients should receive some form of preoperative opioid education. In our study, it was a simple two-minute video with a pamphlet. But it's simple. It's easy to implement. It can help decrease opioid use over time. Thank you for your time.

post-operative pain management

opioid medications

opioid risks

pre-operative education

long-term opioid use