Editorial Commentary: Multiple Factors, Including Multimodal Anesthesia, Can Reduce Opioid Requirements After Rotator Cuff Repair.

Rotator cuff repair often results in significant pain and discomfort early after surgery, whereas longer-term outcomes generally result in substantial improvement. Efforts to decrease pain levels and opioid use after arthroscopic rotator cuff repair have led to the expansion of multimodal analgesia techniques. An interscalene brachial plexus block (ISBPB)-"plus" technique adds a subacromial space injection and "blind" (i.e., without imaging) suprascapular and axillary nerve blocks. Recent research has shown that the ISBPB-plus technique results in less opioid consumption at 48 hours compared with an isolated ISBPB and that both techniques show similar patient satisfaction and postoperative pain scores. Although the optimal multimodal strategy has yet to be determined for specific surgical treatments, decreased opioid consumption is a high priority. Multiple patient factors also require consideration, including severity of pathology, management of depression, preoperative patient education, and cognitive-behavioral therapy. Moreover, surgical technique modifications, cryotherapy, and transcutaneous electrical nerve stimulation may provide pain-reduction benefits.