Rotator cuff repair surgery: PROSPECT guidelines for postoperative pain management

The procedure‐specific postoperative pain management (PROSPECT) working group collaborators have released a procedure‐specific postoperative pain management guidelines for optimal pain management after a rotator cuff repair surgery. This is the first formal guidelines for pain management after rotator cuff repair surgery, published in the journal Anesthesia which is an official publication of Association of Aneathosis.

A rotator cuff is a group of tendons and muscles in our shoulder. It helps in lifting and rotating the arm. It also helps keep our shoulder joint in place. But sometimes, the rotator cuff tendons tear or get pinched by the bones around them. Falling on the arm can injure the rotor cuff and sometimes wear and tear over time can take a toll on the rotor cuff resulting in excruciating pain. Usually, rotor cuff injuries are treated with medicine, however, if the pain still remains then surgery may be the last option. Rotator cuff repair surgery is associated with significant postoperative pain and effective pain control can improve early postoperative rehabilitation.

The PROSPECT guideline was developed to provide clinicians with an evidence‐based approach to pain management after rotator cuff repair which should improve postoperative pain relief. Following are the key recommendations of the guidelines.

1. Whenever possible, rotator cuff repair should be performed using an arthroscopic approach, as it is associated with reduced postoperative pain.


2. Systemic analgesia should include paracetamol and non‐steroidal anti‐inflammatory drugs (NSAID) administered pre‐operatively or intra‐operatively and continued postoperatively.


3. Interscalene brachial plexus blockade is recommended as the first‐choice regional analgesic technique. Suprascapular nerve block, with or without axillary nerve block, may be used as an alternative to interscalene block.


4. A single dose of intravenous (i.v.) dexamethasone is recommended for its ability to increase the analgesic duration of interscalene brachial plexus block, decrease analgesic use and anti‐emetic effects.


5. Opioids should be reserved as rescue analgesia in the postoperative period.

To read the full guideline, click on the link

https://doi.org/10.1111/anae.14796