title: Pain Management After Outpatient Shoulder Arthroscopy: A Systematic Review of Randomized Controlled Trials.
abstract: BACKGROUND
  Effective postoperative pain management after shoulder arthroscopy is a critical component to recovery, rehabilitation, and patient satisfaction.
  
  
  OBJECTIVE
  This systematic review provides a comprehensive overview of level 1 and level 2 evidence regarding postoperative pain management for outpatient arthroscopic shoulder surgery.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  We performed a systematic review of the various modalities reported in the literature for postoperative pain control after outpatient shoulder arthroscopy and analyzed their outcomes. Analgesic regimens reviewed include regional nerve blocks/infusions, subacromial/intra-articular injections or infusions, cryotherapy, and oral medications. Only randomized control trials with level 1 or level 2 evidence that compared 2 or more pain management modalities or placebo were included. We excluded studies without objective measures to quantify postoperative pain within the first postoperative month, subjective pain scale measurements, or narcotic consumption as outcome measures.
  
  
  RESULTS
  A combined total of 40 randomized control trials met our inclusion criteria. Of the 40 included studies, 15 examined nerve blocks, 4 studied oral medication regimens, 12 studied subacromial infusion, 8 compared multiple modalities, and 1 evaluated cryotherapy. Interscalene nerve blocks (ISBs) were found to be the most effective method to control postoperative pain after shoulder arthroscopy. Increasing concentrations, continuous infusions, and patient-controlled methods can be effective for more aggressively controlling pain. Dexamethasone, clonidine, intrabursal oxycodone, and magnesium have all been shown to successfully improve the duration and adequacy of ISBs when used as adjuvants. Oral pregabalin and etoricoxib administered preoperatively have evidence supporting decreased postoperative pain and increased patient satisfaction.
  
  
  CONCLUSIONS
  On the basis of the evidence in this review, we recommend the use of ISBs as the most effective analgesic for outpatient arthroscopic shoulder surgery.
authors.affiliation: Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Warrender
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Usman Ali M
authors.initials: UAM
authors.lastname: Syed
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Sommer
authors.initials: S
authors.lastname: Hammoud
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: William
authors.initials: W
authors.lastname: Emper
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Ciccotti
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Abboud
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Freedman
mesh_terms: D000553:Ambulatory Care; D000700:Analgesics / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D001182:Arthroscopy / Q000009:adverse effects* / Q000379:methods; D017679:Cryotherapy; D006801:Humans; D007270:Injections, Intra-Articular; D009407:Nerve Block; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D016032:Randomized Controlled Trials as Topic; D012782:Shoulder / Q000601:surgery*
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local
keywords: intra-articular injections; oral medication; pain management; regional nerve block; shoulder arthroscopy; subacromial infusion