Pain medicine cocktail therapy after arthroscopic rotator cuff repair shows benefits
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In patients who had arthroscopic rotator cuff repair, use of a postoperative pain medicine cocktail therapy showed benefits, according to findings.
Takeshi Teratani, MD, PhD, of the Ouryouji Orthopedic Hospital in Japan, analyzed the effectiveness of cocktail therapy after arthroscopic rotator cuff repair (ARCR).
Teratani examined data from the double-masked trial of 128 shoulders that received ARCR. Patients were equally stratified into two groups: a control group that received 20 mL of 0.75% ropivacaine and saline solution to a total of 42 mL; and a group that had a cocktail comprised of 20 mL of 0.75% ropivacaine, 5 mg of morphine, 0.3 of epinephrine, 2 mg of betamethasone and saline solution to a total of 42 mL.
Following operation, the mixtures were injected into the glenohumeral joint, subacromial bursa, suprascapular nerve and the anterior, middle and posterior locations of the deltoid muscle, based on the treatment group. Visual analog scale scores of patients were recorded postoperatively at increments between 4 and 48 hours. The researcher also determined the number of patients using diclofenac suppositories and buprenorphine hydrochloride, the rate of nausea, adverse effects of delayed wound healing and infection, length of surgery, retear rate and passive shoulder range of motion.
Teratani found no significant difference in age between the cocktail (mean age, 64.2 years; 60.9% were men) and control groups (mean age, 65.2 years; 64.1% were men).
Regarding VAS scores, the 8-, 16- and 24-hour scores after operation were significantly lower in the cocktail group, the researcher wrote. There was also a significantly lower rate of suppository use in the cocktail group.
While the rates of buprenorphine injection (14.1% vs. 39.1%) and nausea (6.3% vs. 15.6%) were lower in the cocktail groups, there were no significant differences between the two groups, Teratani wrote. Passive anterior elevation at 3 months postoperatively was significantly better in the cocktail group compared with the control group (151.6° vs. 145.9°).
“Cocktail therapy combined with single-does interscalene and (suprascapular nerve) block was useful for postoperative pain management after ARCR without an apparent risk of infection or detrimental effect on tendon healing in this study,” the researcher wrote.
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Derek J. Cuff, MD
This study from Japan compared the injection around the shoulder of a "cocktail" of multimodal medications along with an interscalene nerve block to patients receiving just a ropivacaine injection in conjunction with their nerve block for pain management after arthroscopic rotator cuff repair. The authors noted that the multimodal group who received the cocktail injection had lower pain scores than the group that did not receive the cocktail injection. Interestingly, a steroid (betamethasone) was included in this injection cocktail, some of which was inserted into the subacromial space around the repair. Despite that, the authors report an extraordinarily high rate of rotator cuff healing noting a 97% healing rate in the cocktail group, and a 96% healing rate in the control group.
Of note, these rotator cuff repairs were done as an inpatient surgery and a continuous IV administration of fentanyl was done for 20 hours post-operatively to assist with pain management in both cohorts. Most rotator cuff repairs in the United States are done on an outpatient basis, so it is somewhat difficult to apply this post-operative protocol to all rotator cuff repair surgery.
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