Editorial Commentary: Multimodal Analgesia for Rotator Cuff Repair Should Be Individualized Based on Surgical Location and Complexity and Patient Comorbidity

Multimodal analgesia in arthroscopic rotator cuff surgery is commonly used for pain control and to reduce opioid consumption in the early postoperative time and the days following. Indeed, the combination of local anesthetic peripheral nerve blocks and systemic or oral analgesics ensures a better outcome than the isolated use of nonsteroidal anti-inflammatory drugs. In particular, intrascalene block has significant advantages in more complex procedures involving the anterior aspect of the shoulder. However, intrascalene block should be discouraged under conditions of respiratory comorbidity such as severe chronic obstructive pulmonary disease, obstructive sleep apnea, and morbid obesity. In such cases, a multimodal approach based on periarticular infiltration analgesia combined with pharmacologic therapies can ensure excellent pain control with limited use of opioids in the immediate postoperative period. When selecting the best therapeutic combination, it is essential to consider factors that can determine the best balance between safety and effectiveness, such as the complexity of the surgical procedure, preoperative pain, and any comorbidities that could contraindicate the use of certain medications or that could be negatively affected by potential complications or side effects of the analgesic therapy.