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 OJO  Vol.4 No.9 , September 2014
Anatomical Evaluation of a Technique for Suprascapular Nerve Blockade
Abstract: Introduction: Analgesia following shoulder surgery commonly uses interscalene nerve blockade. When contraindicated (i.e. respiratory compromise), suprascapular nerve blockade can provide a viable alternative. Although a number of techniques have been used, Barber in 2005 described a simple method using anatomical landmarks. While theoretically straightforward, substantive evidence supporting the advantages attributed to the technique has yet to be identified. The present study anatomically examines the technique proposed by Barber to critically assess its potential to benefit clinical practice. Materials and Methods: Using the technique proposed by Barber in 2005, the Nevaiser portal was used to introduce a K-wire into the supraspinous fossa in the region of the suprascapular nerve. A spinal needle was inserted in the same manner and left in position in the presumed region of the transverse scapular ligament. Tissue was dissected out around the wire and needle to visualize their proximity to the suprascapular nerve and transverse scapular ligament respectively. Results: The K-wire was consistently located close to the suprascapular nerve with all cases being within 5 mm. Spinal needle placement relative to the transverse scapular ligament was variable with 50% anterior, 25% posterior, and 25% displaced (likely due to dissection). Conclusions: The results illustrate that it is possible to reliably place a needle close to the suprascapular nerve using the technique described by Barber in 2005. This study provides anatomical confirmation of Barbers description of a simple technique and the basis for clinical study.
Cite this paper: Concina, C. , Szarko, M. , Pearse, E. and Tennent, D. (2014) Anatomical Evaluation of a Technique for Suprascapular Nerve Blockade. Open Journal of Orthopedics, 4, 237-242. doi: 10.4236/ojo.2014.49039.
References

[1]   Singelyn, F.J., Hotel, L. and Fabre, B. (2004) Pain Relief after Arthroscopic Shoulder Surgery: A Comparison of Intraarticular Analgesia, Suprascapular Nerve Block, and Interscalene Brachial Plexus Block. Anesthesia Analgesia, 99, 589-592.
http://dx.doi.org/10.1213/01.ANE.0000125112.83117.49

[2]   Seltzer, J.L. (1977) Hoarseness and Horner’s Syndrome after Interscalene Brachial Plexus Block. Anesthesia Analgesia, 56, 585-586.

[3]   Flowers, G.A. and Meyers, J.F. (2004) Pseudoaneurysm after Interscalene Block for a Rotator Cuff Repair. Arthroscopy, 20, 67-69.
http://dx.doi.org/10.1016/j.arthro.2004.04.048

[4]   Benumof, J.L. (2000) Permanent Loss of Cervical Spinal Cord Function Associated with Interscalene Block Performed under General Anesthesia. Anesthesiology, 93, 1541-1544.
http://dx.doi.org/10.1097/00000542-200012000-00033

[5]   Ritchie, E.D., Tong, D., Chung, F., Norris, A.M., Miniaci, A. and Vairavanathan, S.D. (1997) Suprascapular Nerve Block for Postoperative Pain Relief in Arthroscopic Shoulder Surgery: A New Modality. Anesthesia Analgesia, 84, 1306-1312.

[6]   Gottschalk, A., Burmeister, M.A., Radtke, P., Krieg, M., Farokhzad, F., Kreissl, S., Strauss, M. and Standl, T. (2003) Continuous Wound Infiltration with Ropivacaine Reduces Pain and Analgesic Requirement after Shoulder Surgery. Anesthesia Analgesia, 97, 1086-1091.
http://dx.doi.org/10.1213/01.ANE.0000081733.77457.79

[7]   Savoie, F.H., Field, L.D., Jenkins, R.N., Mallon, W.J. and Phelps, R.A. (2000) The Pain Control Infusion Pump for Postoperative Pain Control in Shoulder Surgery. Arthroscopy, 16, 339-342.
http://dx.doi.org/10.1016/S0749-8063(00)90076-8

[8]   Moore, K.L., Dalley, A.F. and Agur, A.M.R. (2013) Clinically Oriented Anatomy. 7th Edition, Lippencott_Williams & Wilkins, Philadelphia, 693-707.

[9]   Vorster, W., Lange, C.P., Briet, R.J., Labuschagne, B.C., du Toit, D.F., Muller, C.J. and de Beer, J.F. (2008) The Sensory Branch Distribution of the Suprascapular Nerve: An Anatomic Study. Journal of Shoulder and Elbow Surgery, 17, 500-502.
http://dx.doi.org/10.1016/j.jse.2007.10.008

[10]   Matsumoto, D., Suenaga, N., Oizumi, N., Hisada, Y. and Minami, A. (2009) A New Nerve Block Procedure for the Suprascapular Nerve Based on a Cadaveric Study. Journal of Shoulder and Elbow Surgery, 18, 607-611.
http://dx.doi.org/10.1016/j.jse.2009.01.005

[11]   Parris, W.C. (1990) Suprascapular Nerve Block: A Safer Technique. Anesthesiology, 72, 580.
http://dx.doi.org/10.1097/00000542-199003000-00041

[12]   Siegenthaler, A., Moriggl, B., Mlekusch, S., Schliessbach, J., Haug, M., Curatolo, M. and Eichenberger, U. (2012) Ultrasound-Guided Suprascapular Nerve Block, Description of a Novel Supraclavicular Approach. Regional Anesthesia and Pain Medicine, 37, 325-328.
http://dx.doi.org/10.1097/AAP.0b013e3182409168

[13]   Barber, F.A. (2005) Suprascapular Nerve Block for Shoulder Arthroscopy. Arthroscopy, 21, 1015.e1-1015.e4

[14]   Neviaser, T.J. (1987) Arthroscopy of the Shoulder. Orthopedic Clinics of North America, 18, 361.

 
 
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