Background and Aims Open subpectoral biceps tenodesis is often performed to treat biceps tendinopathy in conjunction with shoulder arthroscopy. We tested the hypothesis that a Pecs 2 block would provide better analgesia than surgical infiltration following open biceps tenodesis surgery.

Methods Patients were randomly assigned to either the treatment group (Pecs 2 block with 20 mL of 0.25% bupivacaine) or the control group (local infiltration of up to 15 mL of 0.25% bupivacaine by the surgeon). All subjects received an interscalene nerve block using 20 mL of 0.5% bupivacaine, as well as either intravenous sedation or general anesthesia. The primary outcome was opioid utilization during the first 24 hours after surgery (PACU + POD1). Secondary outcomes were NRS pain scores in PACU, on POD1 and POD3, reaction to surgical subpectoral incision (such as motion or tachycardia) and postoperative skin assessment of sensation in the axilla (to evaluate block or infiltration success).

Results At the time of submission, complete data for at least POD1 is available for only 107 participants out of 133 patients enrolled (81%). For the first 24 hours after surgery, the treatment group used 29.8 ± 9.3 mg morphine mg equivalents (MME) vs. 32.2 ± 9.6 for the control group; p = 0.19. There were no differences in terms of reaction to incision, postoperative paresthesia/anesthesia on skin distal to surgical dressing, or postoperative pain scores.

Conclusions Reynolds et al., comparing Pecs 2 block to a sham block, found an analgesic benefit. However, surgical infiltration is simpler and appears to provide comparable analgesia.