• Standard shoulder regional anesthesia (interscalene + superficial cervical plexus blocks) may not adequately anesthetize the anterior shoulder.
• Sensory branches from the intercostobrachial and pectoral nerves may contribute to anterior shoulder pain.
• A modified PECS II block targeting the second and third intercostal spaces was evaluated as an adjunct technique.
• Intraoperative anterior shoulder pain occurred in 56% of patients with standard blocks versus 7% when the modified PECS block was added.
• Sedation requirements dropped from 56% to 7% with the additional block.
• Surgery under regional anesthesia alone was successful in 93% of patients receiving the modified PECS technique.
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