Preoperative Versus Postoperative Interscalene Block in Arthroscopic Rotator Cuff Repair

Postoperative pain remains a major challenge following arthroscopic rotator cuff repair despite advances in multimodal analgesia protocols. Inadequate pain control may delay rehabilitation, increase opioid consumption, prolong hospitalization, and negatively affect patient satisfaction. Ultrasound-guided interscalene block has become a cornerstone of perioperative pain management for shoulder surgery because of its proven analgesic efficacy and favorable safety profile.

Although interscalene block is routinely used in clinical practice, the optimal timing of administration remains controversial. Administration before surgical incision may provide preemptive analgesic effects by attenuating central sensitization and reducing nociceptive input during surgery. In contrast, administration after completion of surgery has been proposed as a strategy to extend the duration of postoperative analgesia. Existing literature provides limited and inconsistent evidence regarding the comparative clinical benefits of these approaches in patients undergoing arthroscopic rotator cuff repair.

This study was designed to evaluate the impact of interscalene block timing within a contemporary shoulder surgery pathway. In addition to its potential influence on perioperative analgesia, the timing of block administration may affect procedural workflow and ultrasound visualization of relevant anatomical structures. Improved understanding of these factors may contribute to optimization of perioperative management strategies and support evidence-based recommendations for regional anesthesia practices in arthroscopic shoulder surgery.

Inclusion criteria

• Adults aged 18 years or older.
• Patients undergoing primary arthroscopic rotator cuff repair.
• Presence of a repairable small-, medium-, or large-sized rotator cuff tear confirmed by clinical and imaging evaluation.
• Receipt of an ultrasound-guided interscalene nerve block as part of perioperative pain management.
• Ability to provide informed consent and comply with study follow-up requirements.

Exclusion criteria

• Irreparable rotator cuff tears.
• Partial-thickness rotator cuff tears not requiring repair.
• Revision rotator cuff repair procedures.
• Concomitant shoulder procedures that could substantially influence postoperative pain or functional outcomes (e.g., shoulder arthroplasty, fracture fixation).
• Previous surgery on the affected shoulder.
• Contraindications to interscalene nerve block, including local anesthetic allergy, infection at the injection site, or severe neurologic disease affecting the brachial plexus.
• Chronic opioid use or opioid dependence before surgery.
• Inability to complete study questionnaires or follow the postoperative rehabilitation protocol.
• Missing baseline or follow-up data required for outcome assessment.