The use of cold therapy unit in the postoperative period influences pain and narcotic use following arthroscopic rotator cuff repair

Opioid overdose is a leading cause of injury-related death in the United States, prompting calls for reform in surgical prescription practices. Cold therapy units (CTUs) have been widely accepted as an adjunct to pharmacologic therapy for pain management, but these devices are not consistently reimbursed by insurance companies and have not been extensively studied in arthroscopic shoulder surgery. The purpose of our study is to assess the impact of a standardized CTU protocol on postoperative pain and opioid consumption following arthroscopic rotator cuff repair (ARCR), along with its effects on early postoperative shoulder functional outcomes. A prospective cohort trial was conducted on adult patients undergoing primary ARCR between June 2023 and November 2024. Patients were instructed to use a commercial CTU at least 4 times daily in 30-minute sessions for a minimum of 2 weeks. Patients documented pain levels and opioid use during their first postoperative week. Patient-reported outcome measures, including the visual analog scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores, were collected preoperatively and at 6 weeks, 3 months, and 6 months postoperatively. A historical cohort that followed the same multimodal pain management protocol but without use of CTU served as a control group for comparison. Fifty patients in the CTU group and 51 patients in the control group were included with no significant differences in demographics between groups. Intraoperatively, there was no difference in distribution of constructs used or number of tendons repaired. VAS scores were lower in the CTU group throughout the first postoperative week, which was statistically significant on postoperative day 2 (3.1 vs. 4.0, P = .03) but below the threshold for clinical significance. The amount of mean total morphine milligram equivalents (MME) used in the first postoperative week was significantly lower in the CTU group (115.2 ± 83.1 MME vs. 168.3 ± 96 MME, P = .02). In multivariable regression, CTU use was significantly associated with decreased postoperative opioid consumption (P = .05). There were significant improvements in ASES and DASH scores in both groups by 3 months and 6 months, respectively, but no difference between groups. A standardized postoperative CTU regimen reduced opioid consumption following ARCR. Patients who used CTUs reported statistically lower but clinically equivocal VAS scores during the first postoperative week. Patient-reported functional outcomes were not affected by CTU use.