Abstract
Introduction: Pain can be severe during the first days after arthroscopic surgery, and acute pain is an important outcome in clinical trials of surgical technique or anaesthetic strategy. A standardized, validated method of assessing acute postoperative pain would improve the quality of clinical studies, and facilitate systematic reviews and meta-analyses. A step on the way towards this standard is to investigate the methods most commonly used in recent literature.Methods: PubMed and CINAHL databases were searched, including studies of arthroscopic rotator cuff surgery with a primary pain-related outcome during the first postoperative week, published in English from 2012 to 2017.Results: A total of 47 studies were included, all measuring pain intensity using a pain rating scale. Most frequently used was the visual analogue scale using the anchors “no pain” and “worst pain imaginable”, with recordings at 1, 2, 4, 6, 8, 12, and 24 hours postoperatively. A total of 34 studies recorded analgesic consumption, usually as average cumulated consumption in mg. Time to first analgesic request or first pain were recorded in 11 studies, and 4 different starting points were used.Discussion: This review describes the currently most common methods of assessing acute postoperative pain in clinical trials of arthroscopic shoulder surgery involving rotator cuff repair, and the large variety of methods applied. Based on this study and international guidelines, several recommendations on how to measure and report postoperative pain outcomes in future trials are proposed.
Highlights
Pain assessment is fundamental in orthopedic surgery to evaluate disease severity as well as postoperative improvement
Recent quality improvement guidelines of acute postoperative pain from the American Pain Society [1], a review [2] and a study protocol [3] of acute postoperative pain after shoulder surgery have defined outcomes to be included in postoperative pain trials, such as “pain intensity” [4,5]
The inclusion criteria were: shoulder surgery, report of any kind of pain assessment within the first postoperative week, and published in English from 30 June 2012 to 30 June 2017. As this search provided more relevant studies for inclusion than first anticipated, this review focused on arthroscopic shoulder surgery including rotator cuff surgery, and pain as the primary outcome
Summary
Pain assessment is fundamental in orthopedic surgery to evaluate disease severity as well as postoperative improvement. When evaluating new surgical interventions and analgesic methods, clinical trials often use acute postoperative pain as an outcome. Recent quality improvement guidelines of acute postoperative pain from the American Pain Society [1], a review [2] and a study protocol [3] of acute postoperative pain after shoulder surgery have defined outcomes to be included in postoperative pain trials, such as “pain intensity” [4,5]. Recommendations for outcome measurements and recordings are lacking [6]. Trials have assessed postoperative pain in a wide variety of ways [2,7,8]
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