Acute postoperative pain after arthroscopic rotator cuff surgery: A review of methods of pain assessment

Abstract

Introduction: Pain can be severe during the first days after arthroscopic surgery, and acute pain is an important outcome in clinical trials of surgical technique or anaesthetic strategy. A standardized, validated method of assessing acute postoperative pain would improve the quality of clinical studies, and facilitate systematic reviews and meta-analyses. A step on the way towards this standard is to investigate the methods most commonly used in recent literature.Methods: PubMed and CINAHL databases were searched, including studies of arthroscopic rotator cuff surgery with a primary pain-related outcome during the first postoperative week, published in English from 2012 to 2017.Results: A total of 47 studies were included, all measuring pain intensity using a pain rating scale. Most frequently used was the visual analogue scale using the anchors “no pain” and “worst pain imaginable”, with recordings at 1, 2, 4, 6, 8, 12, and 24 hours postoperatively. A total of 34 studies recorded analgesic consumption, usually as average cumulated consumption in mg. Time to first analgesic request or first pain were recorded in 11 studies, and 4 different starting points were used.Discussion: This review describes the currently most common methods of assessing acute postoperative pain in clinical trials of arthroscopic shoulder surgery involving rotator cuff repair, and the large variety of methods applied. Based on this study and international guidelines, several recommendations on how to measure and report postoperative pain outcomes in future trials are proposed.

Comparing analgesic efficacy of different interventions after arthroscopic shoulder surgery

“…Although early mobilisation is helpful following surgery such as knee arthroplasty, active shoulder movement soon after surgery is discouraged following rotator cuff surgery as it might disrupt healing of tendon repairs. In a review examining methods of pain assessment after arthroscopic rotator cuff surgery, only eight out of 47 studies measured pain with movement and these used varying methods, including when coughing, motion attempts, and when moving from lying to a sitting position [4]. Although we assume that intensity of pain should correlate with patient satisfaction, it is likely that multiple factors influence this, as has been observed in other studies [5].…”

“…We are not entirely sure of the reason for this. Despite the importance of measuring pain with movement, it is not standardised or commonly performed after shoulder surgery [4]. Although early mobilisation is helpful following surgery such as knee arthroplasty, active shoulder movement soon after surgery is discouraged following rotator cuff surgery as it might disrupt healing of tendon repairs.…”

“…In fact, the net between-group difference in median morphine milligram equivalents of total opioid consumption for postoperative pain control during hospital stay was only 9 mg oral morphine. We would like to remind readers that the recommended minimum clinically important difference of morphine milligram equivalent for postoperative pain control is an absolute reduction of 10 mg intravenous morphine in 24 h [4]. As length of hospital stay was not provided, we cannot determine whether any postoperative opioid sparing effect was clinically significant.…”

Factors Affecting Prolonged Postoperative Pain and Analgesic Use After Arthroscopic Full-Thickness Rotator Cuff Repair

“…16 Prolonged postoperative pain after arthroscopic surgery for rotator cuff repair has not been evaluated previously. 8,28,30,35 Therefore, it is important to identify pre-and intraoperative factors that could be associated with prolonged postoperative pain and analgesic use, allowing surgeons to manage these cases and develop subsequent strategies. This study aimed to evaluate pre-and intraoperative risk factors for prolonged postoperative pain and analgesic use after arthroscopic rotator cuff repair.…”