These authors point out that non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used for postoperative pain management. However, animal studies have demonstrated negative effects of NSAIDs on bone and tendon healing in commonly performed procedures such as rotator cuff repair. Their goal was to evaluate the effects of postoperative NSAID use on opioid use, pain control, and shoulder outcomes after arthroscopic rotator cuff repair using a randomized, double-blinded, placebo-controlled trial.
Patients were randomized using a computer-generated number to receive either ibuprofen (400mg every eight hours for 14 days continuously) or placebo (for the same duration) for postoperative pain control in addition to opioid medication. A total of 50 patients in the placebo group and 51 patients in the ibuprofen group were included. There were no differences in age, race, gender, history of preoperative NSAID or opioid use, or operative findings between groups.
Findings and repair details are shown for the ibuprofen group (left) and the placebo group (right).
Mean total morphine milligram equivalents (MME) used in the first postoperative week was lower in the ibuprofen group compared to the placebo group (168 vs 211, P = 0.04).
Early VAS scores on postoperative day 3, 4, 5, and 6 were lower in the ibuprofen group but there was no difference in mean VAS scores between groups by6 weeks after surgery.
At 6 months, mean forward flexion and ASES scores were higher in the ibuprofen group compared to placebo (162 vs 153 , P = 0.03) and (86 vs 78, P = 0.02), respectively. There were no differences in shoulder motion, SF-12, DASH or ASES scores at 1 year.
At 1 year after surgery, 7 patients in the ibuprofen group had evidence of tendon retear diagnosed on ultrasound (5 partial-thickness, 2 full-thickness) compared to 13 patients in the placebo group (5 partial-thickness, 8 full-thickness) (P = 0.20). Interestinhgly, there was no difference in ASES and DASH scores at 1 year between patients with retears and those with intact repairs in either group.
The authors concluded that (1) postoperative ibuprofen use reduces opioid requirements and decreases patient pain levels in the first week after arthroscopic rotator cuff repair and (2) ibuprofen use after rotator cuff repair is not associated with increased risk of tendon retear.
Comment: This is a well done randomized controlled study. While the investigation did not concern the effect of anti-inflammatory medication on subscapularis healing after arthroplasty, we routinely use scheduled NSAIDs after joint replacement to assist in pain control and early motion; we have not noted problems with subscapularis healing in those patients.
