OJAnes  Vol.3 No.3 , May 2013
Neural Modulation of Hemiparetic Shoulder Pain by Repetitive Ultrasound-Guided Suprascapularis Nerve Block
Abstract: Background: Neural blockade is widely used in clinical practice to alleviate acute or chronic pain, including pain during rehabilitation. To date there is little controlled evidence to confirm the efficacy of nerve blocks in hemiparetic shoulder pain after stroke. Design: This study is a prospective, open label, cohort trial reporting result from a cohort of stroke patients affected by shoulder pain. Aim: As a cohort study report, in which it is often firstly reported the possibility of an association between an observed effect and a specific environmental based on detailed clinical evaluations and histories, we aim to firstly provide clues in identifying Suprascapularis Nerve blockade as further valuable approach for shoulder pain after stroke. Population: We studied a cohort of patients affected by hemiparetic shoulder pain after Stroke. Methods: Our protocol foresees nerve blocks to be performed each 3 out of 4 days (treatment lasting 30 days) in conjunction with a rehabilitation program with the first aim to provide the window of opportunity to proceed with effective rehabilitation. 47 potential study subjects fulfilled the study criteria and were enrolled. Twenty-four subjects were randomised to the study Group to receive SSNB for the pain of their hemiparetic shoulder while 23 subjects randomized to the control Group whose member did not receive SSNB. They received serial blocks each 3 out of 4 days during rehabilitation.Results: Both treatment reported a reduction in the intensity of their shoulder pain, according to data collected from day 1 through day 42 (6 weeks). Study Group patients, receiving SSNBs, reported significant improvement from entry through the whole follow-up period. The efficiency data were higher for SSNB Group after 2 weeks and again for SSNb group at the end of treatment. Conclusion: Excellent pain relief was achieved in SSNB without clinically relevant complications, these patients having a better improvement on pain during rehabilitation, than the control subjects. Great efficacy has been achieved by combining a nerve block and rehabilitation. About Clinical Rehabilitation Impact, we believe that Suprascapularis nerve blocks can help the stroke survivors maintain an ambulatory or outpatient treatment status, maintain participation in a physical therapy or rehabilitation program, decrease the need for analgesics and in some cases lead to a complete pain relief.
Cite this paper: L. Di Lorenzo and S. Domenico, "Neural Modulation of Hemiparetic Shoulder Pain by Repetitive Ultrasound-Guided Suprascapularis Nerve Block," Open Journal of Anesthesiology, Vol. 3 No. 3, 2013, pp. 126-132. doi: 10.4236/ojanes.2013.33030.

[1]   I. Lindgren, A. C. Jõnsson, B. Norrving and A. Lindgren, “Shoulder Pain after Stroke,” A Prospective Population-Based Study Stroke, Vol. 38, 2007, pp. 343-348.

[2]   L. Bender and K. McKenna, “Haemiplegic Shoulder Pain: Defining the Problem and Its Management,” Disability & Rehabilitation, Vol. 23, No. 16, 2001, pp. 698-705. doi:10.1080/09638280110062149

[3]   C. M. Dean, F. H. Mackey and P. Katrak, “Examination of Shoulder Positioning after Stroke: A Randomised Controlled Pilot Trial,” Australian Journal of Physiotherapy, Vol. 46, No. 1, 2000, pp. 35-40.

[4]   M. Widar, L. Samuelssonn, S. Karlsson-Tivenius and G. Ahlstrom, “Long-Term Pain Condition after a Stroke,” Journal of Rehabilitation Medicine, Vol. 34, 2002, pp. 165-170. doi:10.1080/16501970213237

[5]   K. Walsh, “Management of Shoulder Pain in Patients with Stroke,” Postgraduate Medical Journal, Vol. 77, No. 912, 2001, pp. 645-649. doi:10.1136/pmj.77.912.645

[6]   D. Le Bars and J. C. Willer, “Physiology of Pain. Enciclopedié Medico Chirurgicale. I-36-020-A10. Anaesthesia,” 2005.

[7]   G. Varrassi, A. Paladini, F. Marinangeli and R. Gabor, “Neural Modulation by Block and Infusion,” Pain Practice, Vol. 6, No. 1, 2006, pp. 34-38. doi:10.1111/j.1533-2500.2006.00056.x

[8]   C. C. Gunn, “Neuropathic Pain: A New Theory of Chronic Pain of Intrinsic Origin,” Annals of Royal College Physical Surgery of Canada, Vol. 22, 1989, pp. 327-330.

[9]   D. L. Brown, “Somatic or Sympathetic Block for Reflex Sympathetic Dystrophy. Which Is Indicated?” Hand Clinics, Vol. 13, No. 13, 1997, pp. 485-497.

[10]   L. DiLorenzo, M. Pappagallo, R. Gimigliano, et al., “Pain Relief in Early Rehabilitation of Rotator Cuff Tendinitis: Any Role for Indirect Suprascapularis Nerve Block?” Europa Medicophysics, Vol. 42, No. 3, 2006, pp. 195-204.

[11]   S. Shah, F. Vanclay and B. Cooper, “Efficiency, Effectiveness and Duration of Stroke Rehabilitation,” Stroke, Vol. 21, 1990, pp. 241-246. doi:10.1161/01.STR.21.2.241

[12]   M. R. Wassef, “Suprascapular Nerve Block. A New Approach for the Management of Frozen Shoulder,” Anaesthesia, Vol. 47, No. 47, 1992, pp. 120-124. doi:10.1111/j.1365-2044.1992.tb02007.x

[13]   H. M. Werteheim and E. A. Rovenstine, “Suprascapular Nerve Block,” Anesthesiology, Vol. 2, No. 2, 1941, pp. 541-545. doi:10.1097/00000542-194109000-00006

[14]   D. Thw, et al., “Indirect Suprascapular Nerve Block Tecnique.” http// on May 2004

[15]   G. C. Feigl, F. Anderhuber, C. Dorn, W. Pipam, M. Rosmarin and R. Likar, “Regional Anesthesia and Pain Medicine,” The Long Journey of Epidural Steroid Injections, Vol. 32, No. 6, 2007, pp. 488-494.