The Proximal Approach in an Ultrasound-Guided Suprascapular Nerve Block / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to analyze any effectiveness, advantages, and the procedure of an ultrasound-guided suprascapular nerve block via the proximal approach in patients suffering from shoulder pain. MATERIALS AND METHODS: A total of 51 patients treated with nerve block between November 2015 and November 2016 were analyzed. We identified the suprascapular nerve that branches off the superior trunk of the brachial plexus, and found the suprascapular nerve, which is located in the fascial layer between the inferior belly of the omohyoid muscle and the serratus anterior muscle. We then performed a nerve block. We evaluated the visual analogue scale (VAS) of pre- and post-nerve block, and the visualization of the nerve, depth from the skin to the nerve, angle of needle entry, as well as complications. Moreover, we measured the visualization of the nerve, depth from the skin to the nerve in a classic approach, and compared it with the proximal approach. RESULTS: There was significant improvement (p < 0.05) in the mean VAS, from 7.1 to 3.4, without any major complications. Compared with the classic approach, we were able to identify the suprascapular nerve much better (classic 25.5%/proximal 96.1%), and the mean distance from the skin to the nerve (classic 38 mm/proximal 12 mm) was significantly short (p < 0.05), and the mean angle of needle entry was 19 degrees in the proximal approach. CONCLUSION: In an ultrasound-guided suprascapular nerve block by proximal approach, the nerve and needle tip can be more easily identified, which increases accuracy; with a small amount of local anesthetic, more effective pain control can be achieved. Hence, this approach is an effective alternative pain control method for patients suffering from shoulder pain.

Comparison of Arthroscopically Guided Suprascapular Nerve Block and Blinded Axillary Nerve Block vs. Blinded Suprascapular Nerve Block in Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

BACKGROUND: The purpose of this study was to compare the results of arthroscopically guided suprascapular nerve block (SSNB) and blinded axillary nerve block with those of blinded SSNB in terms of postoperative pain and satisfaction within the first 48 hours after arthroscopic rotator cuff repair. METHODS: Forty patients who underwent arthroscopic rotator cuff repair for medium-sized full thickness rotator cuff tears were included in this study. Among them, 20 patients were randomly assigned to group 1 and preemptively underwent blinded SSNB and axillary nerve block of 10 mL 0.25% ropivacaine and received arthroscopically guided SSNB with 10 mL of 0.25% ropivacaine. The other 20 patients were assigned to group 2 and received blinded SSNB with 10 mL of 0.25% ropivacaine. Visual analog scale (VAS) score for pain and patient satisfaction score were assessed 4, 8, 12, 24, 36, and 48 hours postoperatively. RESULTS: The mean VAS score for pain was significantly lower 4, 8, 12, 24, 36, and 48 hours postoperatively in group 1 (group 1 vs. group 2; 5.2 vs. 7.4, 4.1 vs. 6.1, 3.0 vs. 5.1, 2.1 vs. 4.2, 0.9 vs. 3.9, and 1.3 vs. 3.3, respectively). The mean patient satisfaction score was significantly higher at postoperative 4, 8, 12, 24, 36, and 48 hours in group 1 (group 1 vs. group 2; 6.7 vs. 3.9, 7.4 vs. 5.1, 8.8 vs. 5.9, 9.2 vs. 6.7, 9.5 vs. 6.9, and 9.0 vs. 7.2, respectively). CONCLUSIONS: Arthroscopically guided SSNB and blinded axillary nerve block in arthroscopic rotator cuff repair for medium-sized rotator cuff tears provided more improvement in VAS for pain and greater patient satisfaction in the first 48 postoperative hours than blinded SSNB.

Postoperative Analgesia for Shoulder Surgery：a Review of Current Techniques / 中国微创外科杂志

[Summary] Following shoulder surgery , proper regional anesthesia is usually required to minimize the use of opioids .Regional anesthesia techniques commonly used include subacromial or intra-articular local anesthetic infiltration , suprascapular nerve block with or without axillary nerve block , and interscalene block .This paper summarized literatures on the three abovementioned techniques in respect with performance , merits and flaws , and future perspectives .

Postoperative pain relief effect of a suprascapular nerve block before arthroscopic shoulder surgery

BACKGROUND: Arthroscopic shoulder surgery results in severe postoperative pain in 45% of patients which requires a large amount of opioids for relief. We hypothesized that a suprascapular nerve block before arthroscopic shoulder surgery would improve the quality of postoperative pain relief thereby allowing patients to require significantly reduced amounts of opioids. METHODS: Sixty patients were randomized from a elective arthroscopic shoulder surgery list either into a control group (group 1, n = 30) with only intravenous, patient-controlled analgesia (IV PCA) or an experimental group (group 2, n = 30) involving a suprascapular nerve block before arthroscopic shoulder surgery. The patients had an induction of general endotracheal anesthesia with or without suprascapular nerve block before operation. The IV PCA was connected to the patients 10 minutes after induction. Both groups were analyzed by chi square test and t-test. RESULTS: The postoperative VAS scores for group 2 decreased more than those for group 1. In particular, the VAS scores for group 2 within 12 hours after the operation were significantly higher than those 12 hours postoperative, as compared to group 1. CONCLUSIONS: Increased pain relief and less reliance on opioid can be expected through the use of a suprascapular nerve block prior to arthroscopic shoulder surgery.

Pulsed Radiofrequency Lesioning of the Suprascapular Nerve for Referred Shoulder Pain due to Metastatic Liver Cancer: A case report / 대한통증학회지

A diagnosis of shoulder pain is varied and difficult to make. The initial onset of liver cancer is difficult to detect and patients typically do not complain of symptoms as most tumors are asymptomatic. If the symptoms of the patients develop, the first symptom is usually pain that extends from the abdomen to the back and shoulder. A suprascapular nerve block is used in the treatment of the referred shoulder pain due to a metastatic hepatoma, but the effectiveness of the treatment has been limited because of its short duration. Recently, the advent of pulsed radiofrequency (PRF) lesioning has proved a successful treatment for chronic refractory pain involving the peripheral nerves. We experienced a case of a 66-year-old male patient complaining of referred right shoulder pain due to metastatic liver cancer, which was relieved after PRF lesioning of the suprascapular nerve.

Suggestion of Safer and Easier Technique of Suprascapular Nerve Block based on Cadaver Study

OBJECTIVE: To suggest a safer and easier technique of suprascapular nerve block by assessing anatomical relationship of the suprascapular notch from a view point of surface anatomy. METHOD: Fourteen shoulders of seven cadavers were dissected in prone position. The scapular notch was exposed and the articular branch of suprascapular nerve was observed. The length and depth of spine, height and relative position of scapular notch were measured for all of the specimen. RESULTS: The length of the spine was 11.45+/-0.72 cm. The injection point was measured as relative position of scapular notch on the spine. The ratio between distance from medial border of the spine to injection point and from the injection point to posterior angle of acromion was 1.89+/-0.2: 1. The depth of the spine, which was defined as the shortest vertical distance from the injection point to the scapula was 2.69+/-0.43 cm, and the vertical distance from this contact point to the base of the scapular notch, e.g. the height of the scapular notch, was 1.18+/-0.1 cm. CONCLUSION: We expect we could perform suprascapular nerve block easily and safely with suggested surface landmarks and measured data in this study.

Interscalene Brachial Plexus Block Following Suprascapular Nerve Block for Humeral Head Surgery in a Patient with Difficult Supine Position: A case report / 대한마취과학회지

Although shoulder surgery is usually performed during general anesthesia, the use of an interscalene block alone or in combination with other anesthetic procedures is increasing. Blockade of the suprascapular nerve is used in the diagnosis and treatment of shoulder pain and to provide temporary relief from muscle spasm or strain in the supraspinatus or infraspinatus muscle We report a case of a patient that presented with severe shoulder pain who underwent surgery for traumatic humeral head fracture. Anesthesia was provided by an interscalene block follwing suprascapular nerve block.

The Analgesic Effect of Continuous Suprascapular Nerve Block after Arthroscopic Shoulder Surgery / 대한마취과학회지

BACKGROUND: Arthroscopic shoulder surgery is often associated with severe postoperative pain. It is important to control pain in this setting, not only to improve the patient's well-being but also to facilitate rehabilitation. The aim of this study was to investigate the efficacy of a continuous suprascapular nerve block for pain relief after arthroscopic shoulder surgery. METHODS: Forty patients (20 in each group) scheduled for elective arthroscopic shoulder surgery received a suprascapular nerve block and a catheter was introduced before surgery. The patients were received standardized general anesthesia. After surgery, a single bolus of normal saline (Group I) or 0.2% ropivacaine (Group II) 6 ml was injected through a catheter in each group. All patients received either a continuous infusion of normal saline (Group I) or a continuous infusion of 0.2% ropivacaine (Group II) through the catheter at a rate of 3 ml/hr plus a bolus of 3 ml with a lock out time of 30 min. Pain relief was assessed at 2, 4, 8, 12, 24 hours using visual analog scale (VAS) and verbal pain scores (VPS). RESULTS: VAS and VPS were lower in the ropivacaine group (Group II) than in the normal saline group (Group I). There were no complication in either group. CONCLUSIONS: Continuous suprascapular nerve block using 0.2% ropivacaine is a safe and efficacious treatment for postoperative shoulder pain.