During arthroscopic rotator cuff surgery few debridement (like posterior torn labrum debrided with shaver) and trimming and incision of muscle fibers and in addition of insertion like absorbable screw after drilling into the bones and for the entry points of operative assist instruments opening(minimum insertion point). This all operative procedure cause severe pain after surgery. At least first 2-3 weeks it’s challenging to tolerate pain or get assistance from different sources for the pain relief.
Meanwhile it’s challenging for the patient, it’s also a challenge for healthcare providers to provide pain relief after surgical trauma especially in 40 to 60 hours. There are some techniques your surgeon often used to make the patient pain free and increase his or her satisfactory level. Inadequate postoperative pain management can lead to prolonged pain, decreased patient satisfaction, and even functional impairments such as limited range of motion and muscle weakness.
Post-surgical trauma could be compensated or pain free by immobilizing the targeted joint or surface area. Specifically in rotator cuff repair healthcare provider immobilize the shoulder joint with the help of sling.
Sling: a device to support or immobilize the joint by which surgical site is limited in motion and decrease stimuli which comfort the surgical site and repaired joint.
Use of pillow or any other support while sleeping, which gives you good support and restrict the freely hanging of the joint.
During surgery, your surgeon insert catheter with the help of needle to brachial plexus to block the nerve supply to the (arm) targeted muscle more specifically the axillary nerve and supra scapular nerve it is called interscalene brachial block. Many of other anesthetic methods were also trailed but ISSB is like a gold standard procedure during or after rotator cuff repair surgery in post-surgical pain management. After nerve block the surgery is initiated, on completion of surgical procedure surgeon left that catheter exactly right on the desired point after arthroscopically confirmation. This catheter used as outlet for further injecting of anesthetic agent like (0.5% bupivacaine hydrochloride). After the surgery to manage the pain discomfort healthcare individual inject more 0.5% bupivacaine hydrochloride with methylprednisolone acetate into the site through catheter approximately within 24 to 30 hours to relief the post-surgical acute pain phase.
Furthermore,
Systemic pharmacologic therapy
Local, Intra-articular, or topical techniques
Regional anesthetic techniques
Neuraxial anesthetic techniques
Non-pharmacologic therapies
Cognitive modalities, physical therapy, transcutaneous electrical nerve stimulation (TENS)
Analgesic
To manage post-operative pain crisis as 2nd line management are analgesic drugs. They are divided into 2 groups, for the mild pain and severe pain. In post-surgical case pain is in severe category so the mild analgesics (aspirin, paracetamol, and ibuprofen) don’t help with the pain crisis. For the severe pain opioid analgesics (morphine hydrochloride, promedol and fentanyl) are used to relief post-surgical pain. These drugs are somehow effective in pain relief but present with side effects likely opioid analgesics have long been the mainstay of pain relief following orthopedic procedures, current evidence in the literature is indicating the use of non-opioid regimens and multi-modal therapy better conquer post-operative pain. Furthermore, the associated adverse effects of opioids and the ongoing issues with opioid prescriptions worldwide further demonstrate the need for a collective movement towards better, less opioid-dependent analgesic regimens following shoulder surgery. This has led us to reduce the use of routine opioids after surgery and incorporate multimodal therapy of cold compression, paracetamol and opioids only for breakthrough pain for a limited time.
Acupuncture
It is noticed that acupuncture is also seems effective in post-surgical pain management. Systematic review and meta-analysis evaluated that patients having acupuncture and related methods face less pain than the patients with these techniques. The patients having acupuncture tend to be less users of analgesics and prevented from analgesics side effects. The other technique like transcutaneous electric acu point stimulation (TEAS) is also very helpful in in decreasing the post-surgical pain management. It is also noted that use of transcutaneous electric acu point stimulation is so effective that from the day one there is great difference in pain relief after rotator cuff repair surgery.
Emotional counselling
For the management of post-surgical pain many programs with psychological approaches
CBT is most common psychological technique in pain management which use thoughts behavior and emotions are well connected. By counselling in these aspect of psychological ways patient could adaptive with feelings, emotion and can shift for oneself with post-surgical pain management.
These approaches shown efficacy as treatments for pre/perioperative periods for the management of post-surgical pain.
Attention diversion
Meanwhile countering pain intervals in later stages, one can keep doing attention diversion technique to move the direction of his or her attention away from the surgical trauma, in this period reading books of their interest or playing video games or talk to their loved ones can help them with pain management.
Key words: postsurgical pain management, rotator cuff,
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