Postoperative pain control after arthroscopic rotator cuff repair

Uquillas, Carlos; Capogna, Brian; Rossy, William; Mahure, Siddharth A.; Rokito, Andrew S.

doi:10.1016/j.jse.2016.01.026

Cited by 87 publications

(77 citation statements)

References 99 publications

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“… 12 , 13 In orthopedic procedures, more than 40% of patients experience moderate to severe postoperative pain at home. 3 Generally, upon completion of the analgesic effect provided by the local anesthetic present in the peripheral nerve block, the patients follow a prescription with oral opioids to control postoperative pain. Unfortunately, opioids are associated with undesirable side effects, such as pruritus, nausea and vomiting, sedation and constipation.…”

Section: Discussionmentioning

confidence: 99%

“…Interscalene brachial plexus block anesthesia for ARCRs patients, using single injection or continuous infusion of local anesthetics, associated to general anesthesia, 3 may be performed in a less invasive manner with peri-plexus injection ( Fig. 1 ), in which the anesthetic is injected out of the sheath, between it and the fascia of median scalene muscle, which was proven to be as effective as intra-plexus, but safer.…”

Section: Introductionmentioning

confidence: 99%

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Prospective study of ultrasound-guided peri-plexus interscalene block with continuous infusion catheter for arthroscopic rotator cuff repair and postoperative pain control

Gomide¹,

Ruzi²,

Mandim

et al. 2018

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveThis trial investigated postoperative analgesia in arthroscopic rotator cuff repair surgery patients under general anesthesia, associated with ultrasound-guided peri-plexus interscalene brachial plexus block (US-IBPB), and compared single injection to elastomeric pump continuous infusion of local anesthetics. Complications associated to both techniques are described.MethodsIn this prospective, quasi-randomized controlled clinical trial, 68 adults scheduled for elective arthroscopic rotator cuff repair were assigned to receive Group 1 (G1 = 41) US-IBPB with a 20 mL injection of 0.5% peri-plexus ropivacaine, introduction of catheter, injection of 20 mL of 0.5% ropivacaine through continuous catheter infusion of local anesthetic by elastomeric pump (ropivacaine 0.2%, infusion of 5 mL/h). In Group 2 (G2 = 27), US-IBPB, with a single peri-plexus injection of 40 mL ropivacaine 0.5%. In both groups oral analgesics were prescribed, paracetamol 500 mg associated to codeine 30 mg for patients with VAS between 3 and 5, and also oxycodone 20 mg for VAS ≥ 6. The anesthesiology team was available through contact telephones and the patients received a table to complete in order to report pain intensity according to VAS, use of oral medication, and complications related to the catheter and pump, until the third postoperative day.ResultsThe intensity of pain was higher on second day after surgery than on days 1 and 3, in both groups confirmed by the ANOVA test (p = 0.00006) Among the groups, G1 patients had lower pain intensity than G2, (p = 0.000197). G2 patients presented greater pain intensity during all periods studied (days 1, 2, and 3) than G1 patients. Postoperatively, G2 patients had higher consumption of rescue analgesics, nausea, and vomiting (40.74%) vs. G1 (5%) and dizziness (25.92%). No patient with catheter and elastomeric pump (G1) had complications regarding its insertion and maintenance during postoperative period.ConclusionThe quality of analgesia for arthroscopic rotator cuff repair with peri-plexus US-IBPB and continuous infusion with elastomeric pump presented superior postoperative analgesia quality to single puncture IBPB on postoperative days 2 and 3, with lower consumption of rescue opioids in this period.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prospective study of ultrasound-guided peri-plexus interscalene block with continuous infusion catheter for arthroscopic rotator cuff repair and postoperative pain control

Gomide¹,

Ruzi²,

Mandim

et al. 2018

Revista Brasileira de Ortopedia (English Edition)

View full text Add to dashboard Cite

show abstract

“…Moreover, the authors did not assess non‐opioid analgesics like paracetamol and NSAIDs. A narrative review examined modalities for pain relief after arthroscopic rotator cuff repair, however, no specific recommendations were provided except to state that a multimodal analgesia approach is preferred.…”

Section: Introductionmentioning

confidence: 99%

PROSPECT guideline for rotator cuff repair surgery: systematic review and procedure‐specific postoperative pain management recommendations

et al. 2019

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Summary Rotator cuff repair can be associated with significant and difficult to treat postoperative pain. We aimed to evaluate the available literature and develop recommendations for optimal pain management after rotator cuff repair. A systematic review using procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in English from 1 January 2006 to 15 April 2019 assessing postoperative pain after rotator cuff repair using analgesic, anaesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane Databases. Out of 322 eligible studies identified, 59 randomised controlled trials and one systematic review met the inclusion criteria. Pre‐operative and intra‐operative interventions that improved postoperative pain were paracetamol, cyclo‐oxygenase‐2 inhibitors, intravenous dexamethasone, regional analgesia techniques including interscalene block or suprascapular nerve block (with or without axillary nerve block) and arthroscopic surgical technique. Limited evidence was found for pre‐operative gabapentin, perineural adjuncts (opioids, glucocorticoids, or α‐2‐adrenoceptor agonists added to the local anaesthetic solution) or postoperative transcutaneous electrical nerve stimulation. Inconsistent evidence was found for subacromial/intra‐articular injection, and for surgical technique‐linked interventions, such as platelet‐rich plasma. No evidence was found for stellate ganglion block, cervical epidural block, specific postoperative rehabilitation protocols or postoperative compressive cryotherapy. The analgesic regimen for rotator cuff repair should include an arthroscopic approach, paracetamol, non‐steroidal anti‐inflammatory drugs, dexamethasone and a regional analgesic technique (either interscalene block or suprascapular nerve block with or without axillary nerve block), with opioids as rescue analgesics. Further randomised controlled trials are required to confirm the influence of the recommended analgesic regimen on postoperative pain relief.

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“…Patient-controlled analgesics (PCA) morphine, fentanyl, and hydromorphone are common postoperative pain medications that are used frequently after spine surgery. Appropriately control post-operative pain, while increasing patient satisfaction is a factor that providers and institutions are becoming increasingly emphasized (7). However, as prior studies have found associations between post-operative pain and LOS, the effect of the immediate post-operative pain medication administered is relatively unknown.…”

Section: Introductionmentioning

confidence: 99%

Effects of immediate post-operative pain medication on length of hospital stay: does it make a difference?

Elsamadicy¹,

Adogwa²,

Fialkoff³

et al. 2017

J. Spine Surg.

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Postoperative pain control after arthroscopic rotator cuff repair

Cited by 87 publications

References 99 publications

Prospective study of ultrasound-guided peri-plexus interscalene block with continuous infusion catheter for arthroscopic rotator cuff repair and postoperative pain control

Prospective study of ultrasound-guided peri-plexus interscalene block with continuous infusion catheter for arthroscopic rotator cuff repair and postoperative pain control

PROSPECT guideline for rotator cuff repair surgery: systematic review and procedure‐specific postoperative pain management recommendations

Effects of immediate post-operative pain medication on length of hospital stay: does it make a difference?

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