Management of Postoperative Pain after Rotator Cuff Repair

Immediate Pharmacologic Management

The American Academy of Orthopaedic Surgeons recommends initiating scheduled paracetamol (acetaminophen) 1000mg every 6 hours combined with an NSAID, such as ibuprofen 400-800mg every 6-8 hours, for severe muscle spasms causing pain after rotator cuff repair, with opioids reserved strictly for rescue analgesia 1, 2, 3, 4
The PROSPECT guideline emphasizes that this multimodal non-opioid approach should be initiated pre-operatively or intra-operatively and continued postoperatively, with Level II evidence supporting its use 1, 2
NSAIDs or COX-2 inhibitors should be used concurrently with paracetamol, as they provide superior pain relief compared to acetaminophen alone, according to the American Academy of Orthopaedic Surgeons 1, 2

Ice application for 15-20 minutes every 2-3 hours to the affected shoulder is a safe and commonly beneficial treatment, although evidence is limited, as recommended by the American Academy of Orthopaedic Surgeons 3

Interscalene brachial plexus blockade is the first-choice regional technique for severe refractory pain, according to the American Society of Anesthesiologists 1, 2, 4, 5
Suprascapular nerve block with or without axillary nerve block can be used as an alternative, with evidence supporting its effectiveness 1, 2, 4, 5
A single dose of IV dexamethasone can increase the analgesic duration of nerve blocks, as recommended by the American Society of Anesthesiologists 1, 2, 4

The American Academy of Orthopaedic Surgeons recommends avoiding common pitfalls, such as using opioids as first-line treatment, failing to schedule paracetamol around-the-clock, and underutilizing NSAIDs due to concerns about tendon healing 1, 2, 3, 4, 5
The PROSPECT guideline represents the highest quality, most recent systematic review specifically addressing rotator cuff repair pain management, providing Level II evidence for the multimodal approach, and is supported by the American Academy of Orthopaedic Surgeons 1, 2, 8, 9