Shoulder surgery:
halving opioid use after discharge

The block wears off once the patient is home

The pain peak of shoulder surgery does not happen in theatre. It happens at home, on the first night.

Most procedures are covered by an interscalene block. The local anaesthetic injected at the brachial plexus completely numbs the shoulder and the arm during surgery and in the hours that follow. The patient feels nothing at all.

That analgesia lasts 12 to 24 hours. When it lifts, sensation returns abruptly, and with it the pain of a procedure that had never been felt: the area is still traumatised, inflammation is already established, and the filter that masked everything suddenly disappears.

This rebound therefore falls most often on the first night, which is to say at the exact moment the patient has gone home. To which the shoulder adds a feature of its own: lying down, the loss of the gravitational support of the upright posture and the lower neurosensory tolerance at night both amplify the perception of pain. Sleep degrades, which worsens the pain of the following day.

This is the window of maximal analgesic demand, and the one in which the patient is alone.

What the trial establishes, and what it does not

A multicentre randomised controlled trial published in 2024 in The American Journal of Sports Medicine enrolled 200 patients across 5 hospitals in Ontario, operated on the shoulder as a primary or a revision procedure¹.

The device evaluated was the Game Ready® GRPro 2.1 fitted with the ATX shoulder wrap, against the cryotherapy the treating surgeon would usually recommend. Immobilisation, medication and physiotherapy were the same in both groups.

Opioid consumption was halved (median 56.1 against 112 oral morphine milligram equivalents, p = 0.025) and physical function at two weeks was better (61.2 against 54.2, p = 0.041)¹.

Pain scores did not differ between the groups at any timepoint, nor did the other SF-36 subscales¹. Time to cessation of opioids was shorter under cryocompression, 4 days against 6, without reaching significance (p = 0.154)¹.

Cryocompression therefore lets the patient reach the same level of comfort on half the opioids, without lowering reported pain itself.

That is precisely the intended effect within a multimodal strategy. An opioid-naive patient undergoing shoulder surgery carries a documented risk of prolonged consumption beyond the post-operative period², and every milligram not prescribed counts in that context.

The protocol in practice

It starts on return home, the evening of day surgery or the following morning, so as to cover the wearing-off of the block and the first night.

A late evening session, before bed, is particularly useful against nocturnal pain. The wrap goes over or under the sling without compromising immobilisation, and the patient fits it independently once the demonstration has been given.

Cryocompression complements the block, routine paracetamol, non-steroidal anti-inflammatory drugs where they are not contraindicated, rescue opioids at a controlled dose and early passive rehabilitation. It replaces none of them.

Precautions. As long as skin sensation has not returned after the block, avoid prolonged sessions. The dressing stays watertight and the wrap is applied over it. After a Latarjet, reduce compression intensity according to tolerance. In a frail elderly patient, check the ability to fit the device and involve the carer.

Kolde at the patient's home

Kolde rents the Game Ready® GRPro 2.1 directly to the patient's home, with delivery, set-up and a hands-on walkthrough by a member of the team, and support reachable at any hour. Delivery is usually made on the day of surgery or the following morning, so that the first night is covered.