AANA19 Shoulder Access Pass-Analgesic Benefit of PECS II Blockade for Open Subpectoral Biceps Tenodesis: A Randomized, Prospective, Double-Blinded, Control Trial-Dr. Michael Thomas Freehill, M.D.

Video Transcription

Thanks, Brian. This was a study that I performed or was part of performing before I left Wake Forest, and Brian stepped in, so I'd like to thank those co-authors.  This is looking at a PECS block for subpectoral biceps tenodesis. Hard disclosures. So anybody that does the subpectinal tenodesis, I'm sure you've had patients come back or  call and complain, or even in the PACU, the nurses call in and say, yeah, they're very comfortable except for that incision down in the axillary region, so that's why we looked  into this a little bit. Most of us will do an interscaling block, and that is highly successful for good analgesia,  especially with regards to the upper and middle trunks of the plexus. However, the axillary pain is present a lot, and that's because you don't get good blockade  of that axilla and the medial proximal arm because the intercostal nerves and the lower trunk are sometimes spared with regards to this block.  A PECS block was first described by Blanco, he's an anesthesiologist, and this was for radical breast surgery and lymph node dissection, and the way that they would do this block  is they would do what's called a PECS I, and that's between the PEC major and minor. That gets your medial lateral pectoral nerves, usually, and then your PEC II, that's adding  a second aspect of this block where you go between the PEC minor and serratus, and that gets the intercostal nerves.  So what's spared with a normal interscaling block, in theory, should be blocked by this addition.  So our hypothesis was that when the acute pain team would do a block in interscaling, we would randomize whether they get this PECS II, which would mean you go to both the PECS  I and the PECS II in addition versus not receiving it. So there's our methods there, we have this appropriately powered, you can see in our  control group we had 19, in our intervention group we had 18, in our statistical methods. So with regards to our outcomes, visual pain scores at rest, statistically significant,  better when the addition of the PECS block was performed. Axillary pain out until six hours, significantly better, again, when the PECS block was added to the interscaling block.  And PACU opioids, which we all know in this day and age is an important result. And there's our secondary outcomes.  So in conclusion, when your acute pain service does an interscaling block, they can add this  addition of this PECS block and you can expect better pain with reduced resting pain, reduced axillary pain out to six hours, and reduced need for opioids.  So this probably does help you with regards to calls to the office, coming back to the ER, all the other things that come with pain. Thank you.

Video Summary

In this video, the speaker discusses a study they conducted on the use of a PECS (pectoral) block for subpectoral biceps tenodesis. The goal of the study was to address patient discomfort in the axillary region following the procedure. The current method of using an interscaling block was found to be successful in providing analgesia for the upper and middle trunks of the plexus but did not effectively block the axilla and medial proximal arm, resulting in continued pain. The PECS block, which involves blocking the intercostal and pectoral nerves, was added to the interscaling block and found to significantly improve pain scores at rest, axillary pain up to six hours, and reduce the need for opioids. The conclusion suggests that incorporating the PECS block into the procedure can result in improved pain management and reduced patient complaints.

Asset Caption

Concurrent Scientific Session II: Shoulder Paper Presentations 5.4.2019

Keywords

PECS block

pectoral nerves

subpectoral biceps tenodesis

axillary pain

pain management