Editorial Commentary: Pain and Stress Response After Shoulder Arthroscopic Rotator Cuff Repair: Does Interscalene Block Make a Clinically Important Difference?

Abstract

Pain control after arthroscopic rotator cuff repair will invariably encompass a multimodal approach which will include, in some form, an anesthetic block. The authors of "Effects of a Single-Dose Interscalene Block on Pain and Stress Biomarkers in Patients Undergoing Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial" demonstrate better pain control and a decrease in levels of the stress biomarker insulin with the use of a single-dose interscalene block (SISB) and general anesthesia compared to general anesthesia alone. But a closer look at the minimal clinically important difference (MCID) becomes critically important when interpreting the results as the effect may be less than anticipated and the "rebound effect" plays an important role. The notoriously painful rotator cuff repair may need further evaluation beyond the first several days when looking from the patients' perspectives to impact overall satisfaction and utility.