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

O. Toma, B. Persoons, E. Pogatzki‐Zahn, M. Van de Velde, G. P. Joshi, S Schug, H Kehlet, F Bonnet, N Rawal, A Delbos, P Lavand'homme, H Beloeil, J Raeder, A Sauter, E Albrecht, P Lirk

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)anae.14796
JournalAnaesthesia
DOIs
Publication statusE-pub ahead of print - 7 Aug 2019

Fingerprint

Rotator Cuff
Pain Management
Postoperative Pain
Nerve Block
Analgesics
Guidelines
Randomized Controlled Trials
Acetaminophen
Dexamethasone
Opioid Analgesics
Stellate Ganglion
Transcutaneous Electric Nerve Stimulation
Intra-Articular Injections
Cryotherapy
Local Anesthetics
MEDLINE
Analgesia
Glucocorticoids
Anesthetics
Anti-Inflammatory Agents

Cite this

Toma, O. ; Persoons, B. ; Pogatzki‐Zahn, E. ; Van de Velde, M. ; Joshi, G. P. ; Schug, S ; Kehlet, H ; Bonnet, F ; Rawal, N ; Delbos, A ; Lavand'homme, P ; Beloeil, H ; Raeder, J ; Sauter, A ; Albrecht, E ; Lirk, P. / PROSPECT guideline for rotator cuff repair surgery : systematic review and procedure‐specific postoperative pain management recommendations. In: Anaesthesia. 2019 ; pp. anae.14796.
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abstract = "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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Toma, O, Persoons, B, Pogatzki‐Zahn, E, Van de Velde, M, Joshi, GP, Schug, S, Kehlet, H, Bonnet, F, Rawal, N, Delbos, A, Lavand'homme, P, Beloeil, H, Raeder, J, Sauter, A, Albrecht, E & Lirk, P 2019, 'PROSPECT guideline for rotator cuff repair surgery: systematic review and procedure‐specific postoperative pain management recommendations' Anaesthesia, pp. anae.14796. https://doi.org/10.1111/anae.14796

PROSPECT guideline for rotator cuff repair surgery : systematic review and procedure‐specific postoperative pain management recommendations. / Toma, O.; Persoons, B.; Pogatzki‐Zahn, E.; Van de Velde, M.; Joshi, G. P.; Schug, S; Kehlet, H; Bonnet, F; Rawal, N; Delbos, A; Lavand'homme, P; Beloeil, H; Raeder, J; Sauter, A; Albrecht, E; Lirk, P.

In: Anaesthesia, 07.08.2019, p. anae.14796.

Research output: Contribution to journalArticle

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T1 - PROSPECT guideline for rotator cuff repair surgery

T2 - systematic review and procedure‐specific postoperative pain management recommendations

AU - Toma, O.

AU - Persoons, B.

AU - Pogatzki‐Zahn, E.

AU - Van de Velde, M.

AU - Joshi, G. P.

AU - Schug, S

AU - Kehlet, H

AU - Bonnet, F

AU - Rawal, N

AU - Delbos, A

AU - Lavand'homme, P

AU - Beloeil, H

AU - Raeder, J

AU - Sauter, A

AU - Albrecht, E

AU - Lirk, P

PY - 2019/8/7

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AB - 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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