Perioperative anaesthetic considerations for rotator cuff repair surgeries: A current concept review

Abstract

Surgeries for Rotator Cuff (RC) pathologies are required for either trauma or degenerative related aetiologies. Various surgical techniques from open to arthroscopic repair, are being undertaken by orthopaedic surgeons. Peri-operative anaesthetic management of the patients undergoing rotator cuff repair requires understanding the surgical procedure and patient status for optimal anaesthetic planning. Such management mandates a thorough pre-operative evaluation, including clinical history, examination, and relevant investigations. Patients with acute trauma associated Rotator Cuff (RC) tears should be assessed for visceral injuries using appropriate injury evaluation systems before such repairs. On the other hand, patients with degenerative tears tend to be older with associated comorbidities. Hence pre-operative optimisation is necessary according to risk stratification. Anaesthetic techniques for Rotator Cuff (RC) surgery include general anaesthesia or regional anaesthesia. These are individualised according to patient assessment and surgical procedure planned. Knowledge of relevant surgical anatomy is essential for intra-operative, and post-operative neural blockade techniques since optimal peri-operative analgesia improve overall patient recovery. The occurrence of a peri-operative complication should be recognised as timely management improves the patient-related surgical outcomes. We describe the relevance of surgical anatomy, the effect of patient positioning, irrigating fluids, various anaesthetic techniques and an overview of regional and medical interventions to manage pain in patients undergoing for Rotator Cuff (RC) surgery.

Total Intravenous Anesthesia Compared to Inhalational Anesthesia in Patients Undergoing Arthroscopic Rotator Cuff Repair

“…GA with IA is the gold standard anesthesia technique for a wide variety of surgical procedures and is typically safe and effective, although it is accepted that some percentage of patients will experience side effects such as nausea, vomiting, poorly controlled postoperative pain, and postoperative cognitive impairment [6,17]. Several studies from a variety of surgical specialties indicate that TIVA may improve the quality of recovery after surgery by mitigating some of the uncomfortable effects of IA [11,[17][18][19].…”

“…Intraoperative and postoperative analgesia are significant concerns in patients undergoing RCR, as this surgery is associated with significant postoperative pain that affects both short-term patient comfort and longer-term recovery [7]. Regional anesthesia, often in the form of an interscalene nerve block, combined with GA has proven very effective at managing postoperative pain in these patients [6][7][8]15]. It is not known whether the type of GA, when combined with regional anesthesia, influences postoperative pain and intra and postoperative opioid consumption.…”

“…However, RCR is often associated with significant postoperative pain and opioid use; the choice of anesthetic technique used can influence patient outcomes and is an important consideration [5,6]. General anesthesia with an endotracheal tube is typically the standard technique used in RCR due to several factors, including patient positioning and facilitating hypotensive anesthesia to minimize intraoperative blood loss [6]. In patients undergoing RCR, the use of peripheral nerve blocks is proven to be a beneficial adjunct to general anesthesia (GA) for both intraoperative and early postoperative pain control; interscalene blocks are one of the most effective peripheral nerve blocks in RCR [6][7][8].…”

Synchronization of Blood Flow Velocity in the Anterior Humeral Circumflex Artery and Reduction in Night Pain After Arthroscopic Rotator Cuff Repair: A Case Report

“…Therefore, we decided that the benefit of the anti-inflammatory effect of NSAIDs outweighed the harm that NSAIDs may cause in terms of rotator cuff retear. This patient's multimodal administration of celecoxib, paracetamol, and tramadol [ 19 ] resulted in early relief of severe pain and sleep disturbance, and the anti-inflammatory effect was indirectly confirmed by blood flow velocity. Six weeks after the ARCR, our patient's PSQI score was 5, much better than in previously reported results six weeks after surgery [ 15 , 20 ].…”

The changing landscape of rotator cuff surgery

“…Similar advancements in anaesthetic techniques have contributed to safer surgery, offering improved surgical performance to surgeons and better postoperative pain management. 17 We hope you enjoy reading this special issue of the Journal of Clinical Orthopaedics and Trauma on the rotator cuff. This compilation aims to provide the health care professional with an update on this condition.…”