Looking for a block to cover pain from a subpectorolis tenodesis procudure. Have a new ortho fresh out of upper extremity fellowship. He does a lot of rotator cuff repair,with subpectorolis tenodesis. My scalene block works very well for the rotator cuff. Patients arrive in recovery with severe pain under the arm. Any suggestions ??
Hello! anesthesia for the upper inner arm is a recurring problem for regional anesthesia providers for various surgical procedures (biceps tenodesis, high AV fistulas, etc.). I have often been asked what is the best block for a very proximal upper inner arm AV fistula or graft and my answer is usually "a tracheal block" ;) In all seriousness, for open subpectoral biceps tenodesis.....
.....I think the best strategy is to ask the surgeon to infiltrate bupivacaine or ropivacaine into their tenodesis incisional wound intraoperatively. I believe the skin and deep tissue pain can be reasonably (if not entirely) covered by this infiltration and the proximal humerus drilling will be covered by the interscalene block. And although an interscalene catheter is beneficial to prolong analgesia for the rotator cuff repair (and proximal humerus component of the tenodesis) for 3-4 days vs. an 18-24 hour single shot interscalene block, surgical infiltration with bupi or ropi should last long enough to cover the worst of the skin/soft tissue tenodesis pain in the upper/inner arm.
I hope that helps. Cheers- Brandon