Effect of controlled hypotension on postoperative awakening quality in shoulder arthroscopy with lateral decubitus rotator cuff repair

Background: Shoulder arthroscopy is commonly performed to treat shoulder injuries, degenerative conditions, and chronic pain. The quality of postoperative emergence is critical to patient recovery and overall surgical outcomes. However, few studies have investigated whether controlled hypotension affects emergence quality during shoulder arthroscopy. Controlled hypotension can optimize the surgical field, reduce operative time, decrease the risk of intraoperative complications, and enhance the quality of postoperative recovery. These benefits highlight its clinical utility and support its broader adoption in routine practice. A total of 120 patients (aged 18-60 years) scheduled for elective shoulder arthroscopy under general anaesthesia combined with brachial plexus nerve block were enrolled and randomly assigned to either the study group or the control group (n = 60 per group). In the study group, controlled hypotension was applied selectively during two key intraoperative phases: anchor stapling (T1) and suture knotting (T2). In contrast, the control group received continuous controlled hypotension throughout the entire procedure, targeting a 20% reduction in mean arterial pressure (MAP) from baseline upon entry into the operating room. Perioperative vital signs, quality of emergence from anaesthesia, and postoperative complications were recorded and analyzed. The study group exhibited significantly shorter awakening and extubation times compared to the control group (both P < 0.001). Additionally, the incidences of postoperative nausea and vomiting (11.7% vs. 26.7%), shivering (20.0% vs. 45.0%), and agitation (5.0% vs. 16.7%) were significantly lower in the study group than in the control group (P = 0.037, P = 0.003, and P = 0.037, respectively). Multivariable analysis demonstrated that the study group had significantly shorter awakening time (P < 0.001) and extubation time (P < 0.001), as well as a significantly lower incidence of postoperative nausea and vomiting (P = 0.045), independent of confounding factors including temperature, drug dosage, and urine output. Compared to patients who underwent continuous controlled hypotension throughout rotator cuff repair, those who received controlled hypotension only during critical surgical steps-specifically stapling (Fig. 1) and suture knotting (Fig. 2)-experienced higher-quality postoperative awakening and fewer complications. randomized controlled trial, Chinese Clinicl Trial Registration, ChiCTR2400080822(Date08/02/2024).