Rotator cuff injury (RCI) can lead to severe chronic shoulder joint pain. The prevalence of RCI in the general population is approximately 20%, with an incidence rate ranging from 10% to 50%, affecting millions worldwide. Patients with RCI often have sleep disorders and anxiety simultaneously. Currently, the etiology of RCI remains unclear, and a promising treatment strategy is crucial for patients with RCI. Many studies have shown that shoulder arthroscopic surgery is ideal for treating RCI. Arthroscopic surgery has the advantages of being minimally invasive, safe, and precise. With the continuous development of equipment and surgical techniques, arthroscopy has become the primary treatment method for many shoulder joint diseases. Compared with open surgery, arthroscopic surgery can adopt smaller surgical incisions, reduce surgical injuries, improve intra-articular visualization, have more precise surgical operations, and achieve faster postoperative recovery. Therefore, the use of arthroscopy for the treatment of shoulder joint diseases is gradually gaining favor among surgeons and patients. Arthroscopic surgery applies to various shoulder joint surgeries, including rotator cuff tears, shoulder joint instability, and shoulder joint stiffness. Although arthroscopic surgery causes less trauma, the postoperative pain is still very severe, which will aggravate complications such as anxiety and insomnia in patients during the perioperative period. In recent years, the concept of perioperative pain management has gradually received attention. Through preemptive analgesia, multimodal analgesia, and personalized analgesia regimens, the perioperative pain management of patients has been significantly improved. However, the management of perioperative anxiety and insomnia is still insufficient. Appropriate sleep and anxiety management may optimize postoperative recovery, alleviate patient pain, reduce anxiety, increase patient satisfaction, and improve surgical prognosis. Therefore, adequate perioperative sleep and anxiety management are key factors for recovery after arthroscopic shoulder surgery.

To evaluate the clinical efficacy of the perioperative sleep-anxiety management program (alprazolam combined with olanzapine) combined with conventional multimodal analgesia in patients undergoing arthroscopic rotator cuff repair of the shoulder.

A prospective randomized controlled study was conducted from January 2023 to December 2023. Sixty patients scheduled for arthroscopic giant rotator cuff repair were randomly divided into two groups: The study group adopted the conventional multimodal analgesia combined with the sleep-anxiety management program during the perioperative period (oral administration of alprazolam 0.8 mg every night before sleep from 2 days before the operation to 7 days after the operation; if insomnia or anxiety symptoms persisted, olanzapine 5 mg was added orally before sleep) . The control group only received conventional analgesic regimens (oral celecoxib, nerve block, and, when necessary, oxycodone hydrochloride sustained-release tablets and postoperative patient-controlled analgesic pumps) . The leading observation indicators were sleep quality pittsburgh sleep quality index (PSQI) , anxiety state self-rating anxiety scale (SAS) , and resting pain intensity visual analogue scale (VAS) on the 1st, 3rd, and 5th days after the operation. The secondary outcomes included the total dosage of olanzapine, the number of compressions by the analgesic pump, and the Constant-Murley, ASES, and UCLA shoulder joint function scores 6 months and 12 months after the operation.

The sleep quality and anxiety scores of the patients in the study group at each time point during the perioperative period were significantly better than those in the control group (P<0.05) , and the early postoperative resting VAS pain score and the usage of analgesic pumps were lower. Six months after the operation, the shoulder joint function score of the study group was significantly better than that of the control group. However, at 12 months, there was no statistically significant difference between the two groups, suggesting that the sleep-anxiety management program is helpful to improve the early clinical outcome.

The sleep-anxiety management program of alprazolam (0.8 mg) combined with olanzapine (5 mg) when necessary during the perioperative period, combined with conventional analgesic strategies, can significantly improve the sleep quality of patients after arthroscopic rotator cuff repair of the shoulder, relieve anxiety and pain, and promote early functional recovery. Although the early postoperative benefits were significant, there was no intergroup difference in the long-term functional outcome at 12 months, suggesting that the main advantage of this plan was concentrated in the early postoperative recovery stage.