Blinded and stimulator guided comparison of suprascapular nerve block in hemiplegic shoulder pain: a pilot study

Abstract

Objectives: This study aims to compare the superiority of different suprascapular nerve block (SSNB) application methods on hemiplegic shoulder pain (HSP), in a blinded and stimulator guided manner. Patients and methods:Twenty-six stroke patients (19 males, 7 females; mean age 61.0±9.4 years; range 53 to 76 years) meeting the enrollment criteria, were included in this study between September 2014 and November 2014. Patients were randomly divided into two equal groups. Patients in group A received blinded SSNB and patients in group B received stimulator guided SSNB. Range of motion (ROM) (by goniometer) and pain levels (by visual analog scale-VAS) were assessed. Evaluations were made before, one hour after and one week after SSNBs. Results:In each group, VAS pain scores significantly decreased over time (p<0.0001) and a significant increase in terms of flexion and abduction ROM angles (group A: p=0.002 and p=0.010; group B: p=0.004 and p=0.012, respectively) was observed. In addition, internal rotation ROM angles were found to have increased in group B (p=0.036). There were no significant differences in ROM and VAS one hour and one-week change scores between the two groups (p>0.05). Conclusion:Both blinded or stimulator guided suprascapular nerve block techniques were safe and effective for pain relief in hemiplegic shoulder pain management. None of the injection techniques was superior to the other.Keywords: Blinded; hemiplegic shoulder pain; stimulator guided; suprascapular nerve block.Hemiplejik omuz ağrısında kör ve stimülatör kılavuzluğunda supraskapular sinir blokajının karşılaştırılması: Pilot çalışma ÖZ Amaç: Bu çalışmada hemiplejik omuz ağrısında (HOA) kör ve stimülatör kılavuzluğunda, farklı supraskapular sinir blokajı (SSSB) uygulama yöntemlerinin birbirlerine üstünlüğü araştırıldı. Hastalar ve yöntemler:Eylül 2014 -Kasım 2014 tarihleri arasında yapılan bu çalışmaya katılma kriterlerini karşılayan 26 inme hastası (19 erkek, 7 kadın; ort. yaş 61.0±9.4 yıl; dağılım 53-76 yıl) dahil edildi. Hastalar randomize olarak iki eşit gruba ayrıldı. Grup A'daki hastalara kör SSSB, grup B'deki hastalara ise stimülatör kılavuzluğunda SSSB verildi. Eklem hareket açıklığı (EHA) (gonyometre ile) ve ağrı düzeyleri (görsel analog ölçeği-GAÖ ile) değerlendirildi. Ölçümler SSSB öncesinde, bir saat sonrasında ve bir hafta sonrasında yapıldı. Bulgular:Her iki grupta GAÖ ağrı skorlarında zamanla anlamlı olarak azalma (p<0.0001); fleksiyon ve abdüksiyon EHA açılarında (sırasıyla grup A: p=0.002 ve p=0.010; grup B: p=0.004 ve p=0.012) ise anlamlı artış gözlendi. Ek olarak grup B internal rotasyon EHA açılarında artış saptandı (p=0.036). Gruplar arasında, GAÖ ve EHA açıları bir saatlik ve bir haftalık değişim skorlarında anlamlı bir farklılık yoktu (p>0.05).Sonuç: Kör ya da stimülatör kılavuzluğunda yapılan supraskapular sinir blokajı tekniklerinin her ikisi de güvenli ve hemiplejik omuz ağrısı tedavisinde ağrının giderilmesinde etkilidir. Hiçbir enjeksiyon tekniği diğerinden üstün değildir.Anahtar sözcükler: Kör; hemiple...

A systematic review of the methods and drugs used for performing suprascapular nerve block injections for the non-surgical management of chronic shoulder pain

“…We included 53 studies from 14 different countries in this review (Table 1). Of which, 13 studies came from Turkey, 26–38 7 each from Australia 20,23,39,38,39,40–43 and India, 44–50 6 from the United Kingdom, 51–56 4 each from the United States 57–60 and South Korea, 61–64 2 each from Brazil, 65,66 Canada, 67,68 Egypt 69,70 and Italy, 71,72 and 1 each from Colombia, 73 Austria, 74 Nepal 75 and Thailand. 76…”

“…We included 53 studies from 14 different countries in this review (Table 1). Of which, 13 studies came from Turkey, [26][27][28][29][30][31][32][33][34][35][36][37][38] 7 each from Australia 20,23,39,38,39,[40][41][42][43] and India, [44][45][46][47][48][49][50] 6 from the United Kingdom, [51][52][53][54][55][56] 4 each from the United States [57][58][59][60] and South Korea, [61][62][63][64] 2 each from Brazil, 65,66 Canada, 67,68 Egypt 69,70 and Italy, 7...…”

“…Of these, the indirect surface land-marked approach was reported in 20 studies 20,36,[39][40][41][42][43][44]50,[53][54][55]57,65,68,69,72,[74][75][76] and the direct suprascapular notch surface land-marked approach was reported in 10 studies. 27,29,30,35,38,51,56,[59][60][61] In one study, the direct spinoglenoid notch method was used 45 and in one study, a combination of both the direct suprascapular notch and indirect method was used. 52 Ultrasound guidance used alone was reported in 16 studies.…”

“…Local anaesthetic was used in all 53 studies. Local anaesthetics were used alone in 20 studies, 27,29,[58][59][60]62,63,67,68,70,74,76,30,33,37,38,46,49,54,57 used with steroid in 29 studies 20,23,26,28,32,[34][35][36][39][40][41][42][43][44][45]47,48,[50][51][52][53]55,56,64,66,69,71,73,75 and used with a combination of steroid and…”

“…34,55,64 Betamethasone at a volume of 1 mL was used in four studies. 23,27,32,35 Dexamethasone was used in two studies. 69,73 Of which, one study reported using 1 mL of dexamethasone 69 and the other study reported using 4 mg of dexamethasone.…”