Evaluation of Factors Affecting Acute Postoperative Pain Levels After Arthroscopic Rotator Cuff Repair

• Published in: Arthroscopy Vol. 32; no. 7; pp. 1231 - 1236
• Main Authors: Cuff, Derek J., M.D, O'Brien, Kathleen C., B.S, Pupello, Derek R., M.B.A, Santoni, Brandon G., Ph.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2016
• Subjects: Adult; Age Factors; Aged; Arthroscopy; Decompression, Surgical; Female; Humans; Male; Middle Aged; Narcotics - therapeutic use; Orthopedics; Pain Threshold; Pain, Postoperative - etiology; Retrospective Studies; Rotator Cuff Injuries - surgery; Smoking; Visual Analog Scale; Young Adult
• ISSN: 0749-8063; 1526-3231
• DOI: 10.1016/j.arthro.2015.12.021

Purpose To evaluate multiple preoperative and operative factors that may be predictive of and correlate with acute postoperative pain levels after arthroscopic rotator cuff repair. Methods One hundred eighty-one patients underwent arthroscopic rotator cuff surgery along with subacromial decompression and met the inclusion criteria for this study. Postoperative visual analog scale (VAS) scores were obtained on postoperative days 1, 7, and 90. Multivariate linear regression analysis was used to correlate postoperative VAS scores with multiple independent factors, including preoperative subjective pain tolerance, preoperative VAS score, preoperative narcotic use, sex, smoking status, number of suture anchors used, tear size, single- or double-row repair, and patient age. Results Preoperative subjective pain tolerance, notably those patients rating themselves as having an extremely high pain tolerance, was the most significant predictor of high VAS pain scores on both postoperative day 1 ( P  = .0001) and postoperative day 7 ( P < .0001). Preoperative narcotic use was also significantly predictive ( P  = .010) of high pain scores on postoperative day 1 and day 7 ( P  = .019), along with nonsmokers ( P  = .008) and younger patients ( P  = .006) being predictive on day 7. There were no patient factors that were predictive of VAS scores 3 months postoperatively ( P  = .567). Conclusions Preoperative subjective pain tolerance, notably those patients rating themselves as having an extremely high pain tolerance, was the strongest factor predicting high acute pain levels after arthroscopic rotator cuff surgery. Preoperative narcotic use, smokers, and younger patients were also predictive of higher pain levels during the first postoperative week. Level of Evidence Level IV, prognostic case series.