What Are The 5 keys in Pain Control After Shoulder Surgery?

There are several keys in pain control after shoulder surgery. How do you control post-op pain after having shoulder surgery?  You should be pretty comfortable the first few hours afterwards because of the anesthesia.   However in the coming 24 hours, pain is going to set in.   Let’s talk about a few things that will make it easier to recover from shoulder surgery.  As always talk with your surgeon as they will have the best insight of what was done and what will help you post operatively

Why is there pain after shoulder surgery?

Depending on what was done during surgery, it creates swelling, bleeding.  Specifically trauma to the bones and the rotator cuff.   The surgeon often times, almost every time, we’ll do something called a decompression.   This is taking a little bit of bone off right above where the rotator cuff.  Taking that bone off hurts!   

The Keys to Pain Control

Pain Control Key Number 1-  ICE

One of the keys in pain control after shoulder surgery is ice. Ice is important in recovery, specifically for the first 48 hours.  This decreases the inflammation. After 48 hours it probably is not quite as important as an anti inflammatory, but will still help with the pain.  There are many different ways to get the ice to the shoulder.   It doesn’t really matter how.   If you look at the studies as far as if you use a cryo cuff, a cryo cuff with compression, or just ice.  Whatever it doesn’t really matter just making sure that you have ice on that for the first 48 hours as much as possible.  It may be more convenient with the cryocuff, but depending on on your insurance it might not be covered.  I think if it is not too expensive, investing in a cryocuff is worth it.  It is easier with more consistent ice water on the shoulder.  That being said some of my patients still prefer just a simple ice bag that they change out.   We can keep it on almost constantly over the first 48hrs because of the big bulky dressing doesn’t allow the ice to get in quite efficiently.   So when people talk about 20 minutes on 20 minutes off it doesn’t really apply right after shoulder surgery.   So that’s number one it will help decrease the pain and decrease the swelling in the first 24 to 48 hours.

Pain Control Key Number 2- Nerve Block  

There’s lots of questions about the nerve block or a blocker. The block is one keys in pain control after shoulder surgery. Before surgery just before you go to sleep the anesthesiologist (not the orthopedic surgeon) will put a block in the nerves, just as they come out of your neck.  That block will numb your arm up for about 18 hours or so if it’s working well.   It may work a little bit longer or work shorter occasionally.  A block is really helpful especially for the first night.   That first night is pretty painful in the evening and throughout the morning the early morning without a block.  

Yes there are some pluses and minuses of a nerve block.  Some risks, like any other injection are present so make sure you talk with your shoulder surgeon as well as the anesthesiologist. The anesthesiologist is the doctor that will perform the block.  Talk with them and make sure you feel comfortable with them and what their risks and benefits are before you do the nerve block.   In my opinion a nerve block is really important.  One interesting thing is people occasionally are really bothered by the block because the whole arm is numb.  The vast majority of patients like the nerve block.  There are a few people that feel almost claustrophobic with the nerve block.  So think through that as well. 

Pain Control Key Number 3: Oral Pain Meds

In general a nerve block is a good thing, but there will still be a need for oral pain medicine.  A nerve block hopefully will get you through the first night, but after that oral pain meds will be necessary.  Often times several pain meds are used.  A long acting narcotic,  a nerve pain med, and an anti inflammatory for a couple of days.   After that a shorter acting narcotic will typically be used.  

An anti inflammatory that doesn’t irritate the stomach quite as much for the first few days can be helpful as well.  There is some controversy in taking an anti inflammatory after rotator cuff repair.  There is a debate on if they may delay rotator cuff healing.  In my opinion if it is used for two days and then stopped, it’s probably not important.   Talk with your surgeon about their thoughts.  

After a few days a short acting narcotic is typically used.   Essentially that’s every four hours every six hours or so.  Often the meds are taken in the evening of surgery.  The patient is going to have pain when the block wears off, so you want to take it before you need it. 

The nerve modulator gabapentin is often given for the first two days or so to hit the pain a different way.   It helps minimize the number of narcotic pills that are needed.  Obviously that’s important with todays concerns about narcotics and the risk of narcotics.   Gabapentin can help minimize the number of narcotics which also minimizes the side effects of narcotics.  In addition to the ice, and  anti-inflammatory will help decrease the inflammation in the shoulder.  

Talk with your shoulder surgeon and see what their ideas are and perhaps you bring something up new to them.  Multimodal pain medicines can be a good way to minimize your pain after shoulder surgery.   

Pain Control Key Number 4: Sleep Position

Your sling device will be on during the first few days to keep you immobile.  That being said sleeping will be a challenge.  Typically you can get in any position you want, whatever’s most comfortable. However the most comfortable position almost always is a semi-reclined position. How do you get into a semi-reclined position?  A recliner is the most obvious.  But not everybody has a recliner.  I would not go out and buy a recliner if you don’t have one.  You can prop yourself up with pillows.  Also you can use a wedge.  It can be helpful, it’s much cheaper than a recliner but they’re not as cheap as your own pillows.   So you have to weigh that out.  It may be worth it.  It may be a benefit to sleeping and actually not just sleeping.  After surgery you may be more comfortable just sitting down with a little wedge behind you. https://www.amazon.com/Healthex-Bed-Wedge-Pillow-Adjustable

Key number 5: Protection from Harm

Most likely you will be given an immobilizer after surgery.  Often times surgeons say if you’re going to go out use the immobilizer to remind people you have an injured shoulder. That is a  t great idea.  So if you’re going to be out and about make sure you have your sling on even if you don’t really need it.  To help make sure people can see that especially in church or the grocery store.  Now that doesn’t completely protect you, as some people may think there is something wrong with your elbow not your shoulder.  We have a product that goes over the shoulder to remind people that you have an injured shoulder. Check it out if you like! http://www.mybodyprotector.com/shop