Pain Management After Rotator Cuff Surgery: Multimodal Approach
Post‑operative pain control uses a multimodal regimen to minimize opioid use.
Typical Protocol
- Pre‑op: Acetaminophen 1g + celecoxib 200–400 mg (if no contraindication).
- Intra‑op: Interscalene brachial plexus block (ropivacaine 0.2–0.5%) – provides 12–24 hr analgesia.
- Post‑op (first 48–72 hrs):
- Scheduled acetaminophen 1g q6h.
- Scheduled NSAID (celecoxib or meloxicam) if renal/GI safe.
- Opioid (oxycodone 5 mg or hydrocodone 5 mg) q4–6h PRN breakthrough.
- Adjuncts: Ice (20 min on/off), sling immobilization, TENS, lidocaine patches.
- Taper: Transition to PRN only by day 3–5; discontinue opioids by 2 weeks typically.
Safety
- Monitor for respiratory depression, constipation, sedation.
- Avoid alcohol, benzodiazepines with opioids.
- Stool softener (docusate) prophylactically.
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