Early postoperative pain is similar after arthroscopic rotator cuff repair vs. short-stay shoulder arthroplasty: a prospective study.

Background: One of the barriers to counseling patients for shoulder arthroplasty (TSA) is the anticipated pain after surgery. This can be contrasted with the common perception of arthroscopic rotator cuff repair (RCR) surgery being less painful because of the less invasive nature of the procedure. We conducted a prospective study comparing postoperative pain levels and narcotic consumption after TSA to those after RCR.

Methods: This prospective study enrolled 102 patients undergoing short-stay TSA and RCR at a single hospital. Fifty patients underwent RCR and 52 underwent TSA. All participants received a multimodal pain regimen consisting of an interscalene block with liposomal bupivacaine and one of 2 oral pain medication regimens. Patients were provided a daily pain diary to be completed for 14 postoperative days that tracked pain levels, narcotic consumption, and pain location. Patients were excluded for age <40 years, revision surgery, TSA for fracture, history of chronic opioid use, or an inability to adhere to study protocol. Demographics, visual analog scale (VAS) scores, and pain sensitivity questionnaires (PSQs) were collected preoperatively. Primary study outcomes were daily VAS pain scores and narcotic consumption during the 14 days after surgery.

Results: RCR patients were younger (60.6 vs. 68.9 years; P < .01), but other demographics, preoperative pain, and PSQ scores were similar between groups. Peak mean VAS pain levels for RCR and TSA each occurred on postoperative day (POD) 2 and were 4.4 ± 3.1 and 5.1 ± 2.7, respectively (P = .214). There was no significant difference in VAS pain during the 14-day postoperative period between RCR and TSA patients (P > .05) or between anatomic TSA and reverse TSA (P > .05). Narcotic usage was greater for RCR patients at POD 7 (0.5 vs. 0.2 tablets; P = .039) and 8 (0.5 vs. 0.2 tablets; P = .015) compared with TSA patients.

Conclusions: Our study demonstrated that postoperative pain levels do not significantly differ between RCR and short-stay TSA, with greater narcotic usage observed for RCR at 1 week after surgery. These findings support the notion that despite the increased invasiveness of TSA, early postoperative pain is comparable with early pain after RCR.