***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Purpose The goal of the study was to evaluate the efficacy of additional axillary nerve block ( ANB ) with suprascapular nerve block ( SSNB ) and patient-controlled anaesthesia ( PCA ) with no device assistance after arthroscopic rotator cuff repair . The hypothesis is that patients with intravenous ( IV ) PCA and the blockade of the two main nerves ( SSNB + ANB ) experienced lesser pain than patients with IV PCA or IV PCA + SSNB . Methods The 114 patients undergoing arthroscopic rotator cuff repair were allocated r and omly to three groups as follows : group I , intravenous PCA pumps ( only PCA ) ; group II , IV PCA + SSNB using a blind technique ( PCA + SSNB ) ; and group III , IV PCA + SSNB + ANB using a blind technique ( PCA + SSNB + ANB ) . Pain visual analogue scale ( VAS ) scores were evaluated at 1 , 6 , 12 , 24 , 36 , and 48 post-operative hours . Furthermore , the degree of pain was compared according to cuff tear size . Results The pain VAS score of group III was lower than that of the other two groups and was significantly lower at post-operative hours 1 , 6 , and 12 . In addition , the larger cuff tear tended to be indicative of greater pain . However , all groups experienced rebound pain . Conclusion PCA + SSNB + ANB using a blind technique is a better pain control method than PCA + SSNB and only PCA during the initial 12 post-operative hours . PCA + SSNB + ANB is a cost-effective , time-saving , and easily performed method for post-operative pain control as an axis of multimodal pain control strategy .Level of evidence II BACKGROUND Local analgesic injections are commonly used for pain relief after shoulder surgery . The aim of this study was to compare the efficacy of local injections administered in the glenohumeral joint , the subacromial space , or both locations after arthroscopic rotator cuff repair . METHODS Between March 2011 and December 2011 , 121 consecutive patients who had undergone arthroscopic rotator cuff repair surgery were enrolled in the study and all patients were r and omly allocated to 3 groups . In group 1 , 40 patients received a postoperative glenohumeral injection of bupivacaine ( 20 mL ) and lidocaine ( 10 mL ) . In group 2 , 42 patients received the same postoperative injection , but it was administered in the subacromial space . In group 3 , 39 patients received the same amount of local anesthesia but with half injected in the glenohumeral joint and half in the subacromial space . The visual analog scale was used to assess pain intensity before surgery and at postoperative hours 1 , 2 , 6 , 12 , and 24 .  Demerol  was used as a postinjection rescue analgesic , and the total number of administrations was recorded at each time point . RESULTS There were no significant differences between groups in patient age , sex , or rotator cuff tear size ( P > .05 ) . The visual analog scale scores for pain between each group were not significantly different at any time point , including before surgery ( P > .05 ) . In addition , the amount of supplementary analgesic administered was not significantly different between the groups ( P > .05 ) . CONCLUSION Injection of local analgesics after arthroscopic rotator cuff repair relieves postoperative pain regardless of the injection location Purpose This prospect i ve study was undertaken to compare the effectiveness and safety of a multimodal pain control protocol with those of intravenous patient-controlled analgesia in rotator cuff repair . Methods Seventy patients scheduled for rotator cuff repair were r and omized to either a multimodal pain control group ( group 1 , 40 patients ) or an intravenous patient-controlled analgesia group ( group 2 , 30 patients ) . We compared these two groups with respect to level of pain before surgery to the fifth postoperative day , duration of postoperative rehabilitation , consumption of additional analgesics , and adverse effects . Results Mean visual analogue scale scores immediately after surgery ( day 0 ) and on postoperative days 1–5 were 6.9 , 5.5 , 4.3 , 3.3 , 3.0 , and 2.6 in group 1 and 7.8 , 5.9 , 4.4 , 4.7 , 4.3 , and 3.7 in group 2 . Pain relief was significantly better in group 1 on days 0 , 3 , 4 , and 5 ( P = 0.026 , 0.006 , 0.010 , and 0.009 , respectively ) . Furthermore , functional recovery occurred earlier in group 1 . No significant differences were observed between the two groups with respect to nausea , vomiting , urinary retention , and headache ( n.s . ) , but group 1 was found to be significantly less likely to experience dizziness or urticaria ( P = 0.007 , 0.017 , respectively ) . One other significant difference was observed : 1 patient ( 2.5 % ) in group 1 and 6 patients ( 20 % ) in group 2 discontinued regimen because of medication-related adverse effects ( P = 0.016 ) . Conclusion The multimodal pain control protocol was found to offer more effective postoperative pain control with fewer adverse effects than intravenous patient-controlled analgesia . However , achieving adequate pain control within the first 48 h of surgery remains challenging , and thus , the developments of more effective and safer multimodal pain control protocol s are required BACKGROUND : Early mobilization after shoulder surgery plays a vital role in successful functional rehabilitation . However , postoperative pain often reduces , or even prevents , effective physiotherapy . We investigated the effect of analgesia via patient-controlled interscalene technique on early functional rehabilitation after open shoulder surgery . METHODS : Eighty-seven patients were r and omly assigned to one of two groups : patient-controlled continuous interscalene block ( PCISB ) and patient-controlled IV ( opioid ) analgesia ( PCA ) . Interscalene block was performed preoperatively ; otherwise analgesic protocol s were started in the postanesthesia care unit and were continued for 72 h. Physiotherapy was performed for 60 min a day on day 2 and 3 after surgery according to a st and ardized protocol . Maximum mobility was defined as the range of motion that could be achieved with pain as the limiting factor . Efficiency of functional rehabilitation was evaluated 1 day before and 3 days after surgery with the help of a multimodal scoring system ( Constant-Score ) that evaluates pain , daily life activity , strength and range of motion . Maximum intensity of pain was also monitored via Visual Analog Scales for the first 72 h after surgery and during in-hospital physiotherapy . RESULTS : Constant-Score rates were significantly improved by the interscalene block . However , no significant differences in mobility and strength sub-scores were observed between the groups . Compared with PCA , PCISB proved to be beneficial concerning pain at rest at 6 h ( P < 0.001 ) , 24 h ( P = 0.044 ) , and 72 h ( P = 0.013 ) and for pain during physiotherapy at 48 h after surgery ( P = 0.016 ) . CONCLUSION : Compared with opioid-based PCA , PCISB improved analgesia , but not function , during early rehabilitation of the shoulder joint PURPOSE To compare the effect of early versus delayed motion protocol s on quality of life , clinical outcomes , and repair integrity in patients who have undergone arthroscopic single-tendon rotator cuff repair . METHODS This was a prospect i ve , r and omized , investigator-blinded clinical trial . Seventy-three patients from a single surgeon 's practice who underwent arthroscopic repair of a single-tendon rotator cuff tear were r and omized to either an early motion protocol ( starting 2 to 3 days after surgery ) or a delayed motion protocol ( starting 28 days after surgery ) . The primary outcome measure was the Western Ontario Rotator Cuff index ( WORC ) . Secondary outcome measures included clinical outcome scores , integrity of the repair on 6-month magnetic resonance imaging scans , pain scores , physical examination data , and ultrasonography . Study participants were followed up at 3 , 6 , and 12 weeks ; 6 months ; and 1 year postoperatively . RESULTS There was no statistically significant difference in WORC scores at 6 months ( 529 ± 472 in delayed group vs 325 ± 400 in early group , P = .08 ) . Mixed-effects analysis indicated the early group maintained lower WORC scores throughout the postoperative period ( estimated difference of 191 , P = .04 ) . The proportions of patients with tears on the 6-month postoperative magnetic resonance imaging scan were comparable ( 31 % in delayed group vs 34 % in early group , P = .78 ) . CONCLUSIONS There was no difference between the delayed and early motion groups in WORC scores at 6 months after surgery . Early motion was associated with lower WORC scores throughout the postoperative period ; however , both groups had a similar trajectory of improvement , suggesting both protocol s have the same effect on patient-reported improvement . Although failure rates were similar between the groups , the sample size was not sufficient to support a statement regarding the relation between tear morphology and the rehabilitation protocol . LEVEL OF EVIDENCE Level II , lesser- quality r and omized controlled trial Purpose The aim of this study was to compare the pain relieving effect of ultrasound-guided interscalene brachial plexus block ( ISB ) combined with arthroscopy-guided suprascapular nerve block ( SSNB ) with that of ultrasound-guided ISB alone within the first 48 h after arthroscopic rotator cuff repair . Methods Forty-eight patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled . The 24 patients in group 1 received ultrasound-guided ISB and arthroscopy-guided SSNB ; the remaining 24 patients in group 2 underwent ultrasound-guided ISB alone .  Visual analogue scale pain score and patient satisfaction score were checked at 1 , 3 , 6 , 12 , 18 , 24 , and 48 h post-operatively . Results Group 1 had a lower visual analogue scale pain score at 3 , 6 , 12 , 18 , 24 , and 48 h post-operatively ( 1.7 < 2.6 , 1.6 < 4.0 , 3.5 < 5.8 , 3.6 < 5.2 , 3.2 < 4.2 , 1.3 < 2.0 ) , and a higher patient satisfaction score at 6 , 12 , 18 , 24 , and 36 h post-operatively than group 2 ( 7.8 > 6.0 , 6.2 > 4.3 , 6.4 > 5.1 , 6.9 > 5.9 , 7.9 > 7.1 ) . Six patients in group 1 developed rebound pain twice , and the others in group 1 developed it once . All of the patients in group 2 had one rebound phenomenon each ( p = 0.010 ) . The mean timing of rebound pain in group 1 was later than that in group 2 ( 15.5 > 9.3 h , p < 0.001 ) , and the mean size of rebound pain was smaller in group 1 than that in group 2 ( 2.5 > 4.0 , p = 0.001 ) . Conclusion Arthroscopy-guided SSNB combined with ultrasound-guided ISB result ed in lower visual analogue scale pain scores at 3–24 and 48 h post-operatively , and higher patient satisfaction scores at 6–36 h post-operatively with the attenuated rebound pain compared to scores in patients who received ultrasound-guided ISB alone after arthroscopic rotator cuff repair . The combined blocks may relieve post-operative pain more effectively than the single block within 48 h after arthroscopic cuff repair . Level of evidence R and omized controlled trial , Level I. Clinical Trials.gov Identifier : NCT02424630 BACKGROUND  Arthroscopic rotator cuff repair ( ARCR ) can be associated with significant postoperative pain . Concern for opioid abuse has led surgeons to identify alternative , efficacious methods of postoperative analgesia . To determine whether transcutaneous electrical nerve stimulation ( TENS ) can have a similarly beneficial effect after shoulder procedures , we conducted a prospect i ve double-blinded r and omized trial in patients undergoing outpatient ARCR . METHODS All patients undergoing ARCR of a full-thickness rotator cuff tear by the senior authors were identified . Patients with a history of recent narcotic use or prior narcotic abuse and those under management of a pain control specialist were excluded . Patients were r and omized into 2 groups , active or placebo TENS , and used the device for 4 sessions/day for 45 minutes/session for the first postoperative week . All patients received Percocet 5/325 mg ( oxycodone/acetaminophen ) for use as rescue pain pills . One-week narcotic consumption and visual analog scale pain scores were compared between groups . RESULTS The final analysis included 37 patients ( 21 active,16 placebo ) . Baseline and procedural differences were not different between groups . At 1 week postoperatively , patients in the active group had significantly lower pain scores ( 3.6 ± 2.1 vs. 5.8 ± 1.2 ; P= .008 ) . Postoperative Percocet consumption during the initial 48 hours ( 12. 
    Output:
    
Limited evidence was found for pre-operative gabapentin , perineural adjuncts ( opioids , glucocorticoids , or α-2-adrenoceptor agonists added to the local anaesthetic solution ) or postoperative transcutaneous electrical nerve stimulation .
Inconsistent evidence was found for subacromial/intra-articular injection , and for surgical technique-linked interventions , such as platelet-rich plasma .
No evidence was found for stellate ganglion block , cervical epidural block , specific postoperative rehabilitation protocol s or postoperative compressive cryotherapy .