Shoulder surgery: cryocompression reduces postoperative opioid use
Shoulder surgery: cryocompression reduces postoperative opioid use
Professional Resources · Kolde · Reading time: 11 min
Why shoulder pain is different
The challenge of nocturnal pain
One feature sets shoulder surgery apart from other orthopaedic procedures: nocturnal pain. Lying down, the loss of the gravitational support of the upright posture and the lower neurosensory tolerance at night all amplify the perception of pain. This pain causes sleep disturbance, which in turn worsens daytime pain and compromises overall recovery. It is precisely during these first nights that the temptation to reach for opioids is strongest.
The wearing-off of the interscalene block
Most shoulder procedures benefit from a peri-operative interscalene block. The anaesthetist injects a local anaesthetic at the level of the brachial plexus, at the base of the neck, which completely numbs the shoulder and arm during surgery and in the hours that follow. The patient feels no pain at all, but this analgesia is temporary: it lasts only 12 to 24 hours.
When the anaesthetic wears off, the block lifts. Sensation returns abruptly, and with it the pain of the surgery that had never been felt until then: the area is still traumatised by the procedure, inflammation is already established, but the "filter" that masked the pain suddenly disappears. The result is a sudden pain peak (the "rebound pain") between the 12th and 24th hour, that is to say most often the first night, at the exact moment when the patient has gone home. Cryocompression started as soon as the patient returns home is specifically aimed at blunting this peak.
The wearing-off of the interscalene block (12 to 24 h post-op) is the period of maximal analgesic demand, and often the one where the patient is alone at home. Home cryocompression covers exactly this critical window.
Mechanisms of action of cryocompression
On a joint as convex and mobile as the shoulder, cryocompression acts on three complementary levers, where a simple ice pack covers only one.3
Less pain and oedema
Vasoconstriction, slowing of nociceptive conduction and of local metabolism, with no central sedative effect.
Drainage and close contact
Modulated between 5 and 75 mmHg, it drains oedema and presses the cold wrap against the contours of the shoulder (acromion, coracoid).
Opioid-sparing analgesia
Cold penetrates more deeply under pressure: a sustained analgesic effect that reduces the need for opioids.
What does the key study show?
2024 multicentre randomised trial
A multicentre randomised controlled trial published in 2024 (AOSSM / The Orthopaedic Journal of Sports Medicine) compared dynamic cryocompression (Game Ready® with a shoulder wrap) to standard cryotherapy (ice pack) after shoulder surgery.4 200 patients, 5 hospitals, identical analgesic protocol. Primary endpoint: opioid consumption in oral morphine milligram equivalents (OMME).
The key lesson is not that cryocompression abolishes pain: pain scores (VAS) are equivalent between the two groups. It is that it allows patients to reach the same level of comfort with half the opioids. Within a logic of multimodal analgesia and prevention of dependence, that is exactly the intended effect.
Cryocompression does not abolish postoperative pain; it allows patients to reach the same level of comfort with half the opioids. That is the expected benefit of a multimodal strategy.
An earlier randomised study (2015), on 46 patients after rotator cuff repair or subacromial decompression, found no difference in total morphine consumption but demonstrated better sleep on the night following surgery in the cryocompression group, confirming the particular value of this modality for the nocturnal pain of the shoulder.5
Clinical implications: practical protocol
Timing
Starting cryocompression as soon as the patient returns home, the evening of outpatient surgery or the next morning, is aimed at covering the wearing-off of the interscalene block and the first postoperative night: the moment of "rebound pain" and of maximal analgesic demand.
The protocol in practice
A late-evening session, before bed, is particularly useful to limit nocturnal pain. The shoulder wrap is applied over or under the sling, without compromising immobilisation: the patient can fit it independently once the demonstration has been given.
Place within the multimodal strategy
Cryocompression complements the interscalene block, routine paracetamol, non-steroidal anti-inflammatory drugs where not contraindicated (to be discussed after rotator cuff repair), opioids as rescue at a controlled dose and early passive rehabilitation. It replaces none of these modalities; it reduces reliance on opioids.
Precautions
Interscalene block
As long as skin sensation has not returned, avoid prolonged sessions
Surgical wound
Keep a waterproof dressing in place, wrap applied over the dressing
Recent bony surgery
After a Latarjet, reduce compression intensity according to tolerance
Frail elderly patient
Check the ability to fit the device and involve the carer
Kolde's role: bridging the gap between hospital and rehabilitation
The clinical benefit of cryocompression is now quantified. What remains is to make it accessible. Many patients are discharged the same day or at day 1 after shoulder surgery, start physiotherapy between day 7 and day 14, and find themselves during this first week with ice packs as their only non-pharmacological analgesic tool.
Kolde is a home-rental service for the Game Ready device, designed for this window.
On the day of surgery
Kolde delivers and sets up the device with a dedicated shoulder wrap, usually on the day of surgery or the next morning, to cover the first postoperative night.
Set-up and demonstration
A trained technician sets up the device and explains its use to the patient and their circle, compatibly with the sling.
Independent use, 24/7 support
30-minute sessions, before and after physiotherapy sessions. As the first night is the most critical, Kolde support remains reachable at any time.
End of rental and device collection
At the end of the rental, Kolde collects the device from the patient's home, with no travel required on their part. No deposit is required.
Conclusion: a validated opioid-sparing effect
The 2024 multicentre randomised trial quantifies for the first time, across 200 patients, the impact of cryocompression on opioid consumption after shoulder surgery: a median reduction of around 50%, a significant improvement in physical function, and a preserved safety profile. In a context where reducing opioid prescribing has become a public-health imperative, these results place cryocompression among the most useful modalities of a multimodal postoperative strategy.
For the surgeon as much as for the physiotherapist, the challenge now shifts towards access to the device at home, from hospital discharge onwards. That is the mission Kolde has set itself.
After shoulder surgery, cryocompression allows patients to reach the same level of pain with half the opioids and improves physical function, with no increase in adverse events. These data support its integration into a multimodal analgesia strategy, from hospital discharge to the home.
References
- Brummett CM, Waljee JF, Goesling J, Moser S, Lin P, Englesbe MJ, Bohnert ASB, Kheterpal S, Nallamothu BK. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surgery. 2017. PMID 28403427.
- Hsu JR, Mir H, Wally MK, Seymour RB, and the Orthopaedic Trauma Association Musculoskeletal Pain Task Force. Clinical practice guidelines for pain management in acute musculoskeletal injury. Journal of Orthopaedic Trauma. 2019. PMID 30681429.
- Block JE. Cold and compression in the management of musculoskeletal injuries and orthopedic operative procedures: a narrative review. Open Access Journal of Sports Medicine. 2010. PMID 24198548.
- Cryocompression results in a significant decrease in opioid consumption following shoulder surgery: a multicentre randomised controlled trial. Orthopaedic Journal of Sports Medicine (AOSSM 2024). 2024.
- Kraeutler MJ, Reynolds KA, Long C, McCarty EC. Compressive cryotherapy versus ice: a prospective, randomized study on postoperative pain in patients undergoing arthroscopic rotator cuff repair or subacromial decompression. Journal of Shoulder and Elbow Surgery. 2015. PMID 25825138.
This article is for information only. It does not replace the advice of a surgeon, doctor or physiotherapist, and it does not constitute a treatment protocol. Indications, contraindications and session parameters remain the responsibility of the prescribing clinician.