Effect of Local Anesthetic Concentration on Rebound Pain: A Randomized Control Study

Effect of Local Anesthetic Concentration on Rebound Pain: A Randomized Control Study

Randomized control study that compares different concentrations of local anesthetic to investigate whether a lower concentration of local anesthetic would contribute to lower rebound pain scores at 24 hours post op in patients undergoing anatomic or reverse total shoulder arthroplasty.

Inclusion Criteria:

• Total shoulder replacement patients (anatomic and reverse)
• Adult patients (greater than or equal to 18 years)
• Any gender
• Any race

Exclusion Criteria:

• - Chronic Pain diagnoses including:
• substance/opioid use disorder
• complex regional pain syndromes
• fibromyalgia
• Daily persistent opioid use spanning 3 months prior to surgery date
• Allergy to local anesthetics or NSAIDS
• Respiratory pathologies including:
• CPAP- non-compliant / untreated obstructive sleep apnea
• COPD
• Restrictive lung disease (pulmonary fibrosis, interstitial pneumonia, etc)
• Contralateral diaphragm dysfunction
• BMI > 40
• Ipsilateral extremity pre-existing nerve injury
• GFR < 60
• NSAID contraindications
• Inability to follow up
• Revision surgery
• Patients requesting block as primary (avoidance of general anesthesia)
• Need or request for brachial plexus catheter or liposomal bupivacaine
• Vulnerable populations (pregnancy, incarceration, etc)
• non-English speaking