Analgesic Benefit of PECS Blocks for Biceps Tenodesis Shoulder Surgery
Condition: Biceps Tendonitis
MeSH terms: Tendinopathy
Intervention: PECS "Pectoralis" 1 and 2 Blocks; Interscalene Block; Sham Block; Solution for Injection in Interscalene Block; Solution for Injection in Sham Block; Solution for Injection PECS Blocks
Intervention description: An interscalene and a PECS "Pectoralis" 1 and 2 block will be performed on the subjects.; An interscalene block will be performed on the subjects.; 20mL of 0.25% bupivacaine with 1:400,000 epinephrine and 1:600,000 clonidine; Lidocaine 1%; 10mL of 0.25% bupivacaine with 1:400,000 epinephrine and 1:600,000 clonidine dosed at the PECS1 location and 20mL of 0.25% bupivacaine with 1:400,000 epinephrine and 1:600,000 clonidine dosed at the PECS2 location
Intervention MeSH terms: Lidocaine; Clonidine; Epinephrine; Racepinephrine; Bupivacaine; Pharmaceutical Solutions; Epinephryl borate
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Enrollment: 40.0
Sex: All
Minimum age: 18 Years
Maximum age: 80 Years
Healthy volunteers: Accepts Healthy Volunteers

Summary:

      The standard practice for arthroscopic shoulder surgery at our institution is a general
      anesthetic with a long-acting interscalene block for post-operative pain control, which can
      reduce the amount of opiates needed after surgery. The interscalene block is effective in
      providing analgesia to the majority of the shoulder joint and has been shown to reduce
      post-operative pain scores after arthroscopic shoulder surgeries. However, there is a subset
      of arthroscopic shoulder surgery patients who have pain in the axilla even in the setting of
      a functioning interscalene brachial plexus nerve block. One of our surgeons has reported a
      high incidence of axillary pain in patients who undergo a sub-pectoral biceps tenodesis as
      part of their arthroscopic procedure. A newly described nerve block approach to the nerves
      that supply sensation to the axillary region called the PECS "Pectoralis" 1 & 2 block may
      provide additional analgesia to these patients.

      The purpose of this prospective, randomized, observer and patient blinded, single-center,
      sham block trial is to determine if the addition of PECS blocks to an interscalene block will
      reduce the severity of axillary pain following arthroscopic shoulder surgery that involves a
      sub-pectoral biceps tenodesis. Secondarily, the study will assess the duration of PECS 1 & 2
      and whether the block reduces post-operative opioid usage. We hypothesize that the addition
      of the PECS 1 & 2 block will reduce the severity of axillary pain at 6hrs and reduce
      postoperative narcotic usage for the first 24 hours.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Adults, between 18 and 80 years of age

          -  Ability to take pills

          -  Agreement to a regional with general anesthesia technique

        Exclusion Criteria:

          -  Allergy to amide local anesthetics

          -  Presence of a progressive neurological deficit

          -  pre-existing coagulopathy

          -  Current infection

          -  Significant pulmonary disease contraindicating phrenic nerve blockade

          -  Chronic use of an opioid analgesic (>3 months of a combined total of more than 40mg
             oxycodone equivalents a day)

          -  Inability to obtain ultrasound images of anatomy due to obesity.

          -  Pregnancy