Efficacy of Transdermal 4% Lidocaine Patches for Post-operative Pain Management Following Arthroscopic Rotator Cuff Repair: A Prospective Trial

Abstract Background Postoperative pain management continues to be a challenging aspect of patient care. Lidocaine patches have shown efficacy in reducing pain in other surgical specialties and mixed results in orthopedic trials. We sought to determine the effectiveness of non-prescription lidocaine patches in reducing postoperative pain following arthroscopic rotator cuff repair Methods Patients undergoing primary arthroscopic rotator cuff repair were recruited from 3 surgeons at a single institution. All patients of each surgeon were randomized to a lidocaine patch or control group, with crossover occurring at midpoint. Experimental group patients received twenty-six 4% lidocaine gel-patches. They were provided written and visual instructions to begin wearing the lidocaine patches during daytime on postoperative day (POD) 2. They were to be switched every 8 hours and removed overnight. Control group patients received normal standard of care but did not receive a placebo control. Exclusion criteria included workman’s compensation claims, age Results 80 (40 control, 40 lidocaine) patients were enrolled, with 53 completing follow-up. Groups were demographically similar in age (P=0.22), gender (P=0.20), and BMI (P=0.77). They were similar in tear pattern (P=0.95), concomitant acromioplasty (P=0.44), concomitant biceps tenodesis (P=0.07), and number of anchors used (P=0.25). There was no difference in ASES scores at any time points (range P=0.28 – P=0.97). Reported 14-day pain logs were not different between study groups at any time points (range P=0.07 – P=0.99). There was no difference in opioid consumption in the first 14 days following surgery (P= 0.38). The lidocaine group reported less satisfaction with their pain management beginning in the evening of postoperative day 2 (P=0.05). This continued until the afternoon of POD8 (P=0.03). Conclusion Transdermal 4% lidocaine patches are not effective in reducing pain or opioid consumption following arthroscopic rotator cuff repair and were associated with reduced patient satisfaction.