As these authors point out nonsteroidal 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 after commonly performed procedures such as rotator cuff repair.
They sought to evaluate the effects of postoperative NSAID use on opioid use, pain control, and outcomes after primary arthroscopic rotator cuff repair in a randomized, double-blind, placebo-controlled trial. Patients were randomized to receive ibuprofen (n=51) or placebo (n=50) for 2 weeks postoperatively, in addition to opioid medication. Over 80% of the tears in both groups were of small or medium size and involved only the supraspinatus.
All patients received a single-shot interscalene regional anesthetic preoperatively. Rotator cuff tears were repaired with either single or double-row constructs. Patients with biceps pathology were
treated with arthroscopic debridement or tenotomy. Those who underwent open biceps tenodesis were excluded from the study to reduce the introduction of confounding factors from a larger, open approach that may influence postoperative pain control.
All patients were immobilized in a shoulder sling with an abduction pillow for 6 weeks after surgery.
The mean total morphine milligram equivalents (MMEs) used in the first postoperative week was lower in the ibuprofen group than in the placebo group (168 MMEs vs. 211 MMEs, P ..04).
Early VAS scores on postoperative days 3, 4, 5, and 6 were lower in the ibuprofen group, but there was no difference in mean VAS scores between groups by 6 weeks after surgery.
At 6 months, mean forward flexion and the mean ASES score were higher in the ibuprofen group than in the placebo group: 162 vs. 153 (P ..03) and 86 vs. 78 (P ..02), respectively.
There were no differences in shoulder motion or 12-item Short Form Survey, Disabilities of the Arm, Shoulder and Hand, or ASES scores at 1 year.
At 1 year after surgery, 85 patients underwent ultrasound examination at 1 year after surgery. 7 (16%) patients in the ibuprofen group had evidence of tendon retear diagnosed on ultrasound (5 partial and 2 full thickness) compared with 13 (30%) patients in the placebo group (5 partial and 8 full thickness).
There was no difference in the ASES and DASH scores at 1 year between patients with retears and those with intact repairs in either group.
Comment: This is a well done and much needed study. Patients with rotator cuff repair often have substantial postoperative pain. This study provides evidence that ibuprofen can help in postoperative pain management without increasing the rate of re-tear.
It is of interest that (1) the rate of re-tear of these repairs of small-moderate cuff tears was substantial and (2) that re-tear did not appear to affect the patients' self-assessed functional outcome.
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