Summary

The addition of a PECS II block to an ISB for patients undergoing arthroscopic shoulder surgery with an open subpectoral biceps tenodesis significantly improved postoperative analgesia and reduced the need for opioids in the PACU.

Abstract

Background

Axillary pain is common following arthroscopic shoulder surgery with an open subpectoral biceps tenodesis. We hypothesized that adding a PECS II nerve block (PECS) to an interscalene block (ISB) would improve postoperative analgesia.

Methods

Forty patients enrolled in this prospective, randomised, observer and patient blinded, single institution trial. Forty patients received a single-injection ISB with 20 ml (0.25% bupivacaine, 1:400,000 epinephrine, 1:600,000 clonidine). The intervention arm (ISB+PECS) consisted of 20 patients who also received a PECS II block using 30 ml (0.25% bupivacaine, 1:400,000 epinephrine, 1:600,000 clonidine). Twenty control group (ISB) patients received a sham PECS block. The primary outcome was postoperative pain scores at 6-h using the Numeric Rating Scale (range 0-10). Secondary outcomes included the presence of axillary pain at 6-h, post-anaesthesia care unit opioid administration, PACU length-of-stay, NRS pain scores at 24-h, cumulative opioid usage post-discharge through 24-h, nausea or vomiting during the first 24-h, and PECS II block duration. Data were analysed using an intention-to-treat methodology.

Results

Pain scores (NRS 0-10) at 6-h differed significantly between groups (ISB+PECS 1.26 ± 2.5 vs ISB 3.11±2.6 (mean±SD, P = 0.028). Fewer patients in the ISB+PECS group reported axillary pain at 6-h and less required opioids in the PACU. There were no differences in any of the remaining secondary outcomes.

Conclusion

The addition of a PECS II block to an ISB for patients undergoing arthroscopic shoulder surgery with an open subpectoral biceps tenodesis significantly improved postoperative analgesia and reduced the need for opioids in the PACU.