Blockade of the Suprascapular Nerve: A Radiological and Cadaveric Study Comparing Landmark and Ultrasound-guided Blocking Techniques

Lancaster, S.; Clark, Damian; Redpath, Y.; Hughes, David; Crowther, Mark; Lewis, Simon

doi:10.1111/sae.12005

Cited by 6 publications

(3 citation statements)

References 10 publications

(13 reference statements)

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“…These measurements were used to calculate an overall '3-dimensional' (3D) distance between the closest point of the nerve wire to where the drill bit passes through the posterior cortex of the humerus. This technique has previously been used to measure distances between structures radiologically [13].…”

Section: Methodsmentioning

confidence: 99%

Proximity of the axillary nerve during bicortical drilling for biceps tenodesis

Lancaster

Smith

Ogunleye

et al. 2014

Knee Surg Sports Traumatol Arthrosc

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This study highlights the need for caution when drilling the posterior humeral cortex during biceps tenodesis, particularly during drilling at the superior insertion of PM as this is the location that poses the highest risk to the axillary nerve. To our knowledge, this is the first cadaveric study to radiologically assess the proximity of the axillary nerve to the positions of biceps tenodesis. Surgeons should therefore be cautious when performing bicortical drilling for biceps tenodesis, and a supero-lateral drill trajectory would pose a smaller risk to the axillary nerve.

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Section: Methodsmentioning

confidence: 99%

Proximity of the axillary nerve during bicortical drilling for biceps tenodesis

Lancaster

Smith

Ogunleye

et al. 2014

Knee Surg Sports Traumatol Arthrosc

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“…Metaregression was performed only if at least four studies were included in an estimate of effect and each group within the covariate included at least two randomized, controlled trials. The metaregression analysis examined the following covariates: (1) block approach (lateral, posterior, or anterior) 29,30 ; (2) block localization (ultrasound vs. landmark vs. paresthesia vs. nerve stimulator) 31,32 ; (3) short-/intermediate-acting (lidocaine and mepivacaine) versus long-acting (bupivacaine, levobupivacaine, and ropivacaine) local anesthetics 33 ; (4) local anesthetic dose in block (converted to milligrams of bupivacaine) 34 ; (5) local anesthetic volume in block (milliliters); (6) local anesthetic dose in spinal anesthetic (converted to milligrams of bupivacaine) 34 ; (7) type of short-acting narcotic used in spinal anesthetic (fentanyl vs. sufentanil vs. cocaine vs. none); (8) dose of long-acting narcotic used in spinal anesthetic (micrograms); (9) type of spinal anesthetic used (combined spinal epidural vs. single-injection spinal anesthetic); and (10) postoperative analgesic modality (multimodal = combines opioid and other adjuvants vs. unimodal = uses opioids only). 35,36 assessment of Publication Bias A funnel plot was generated and examined for publication bias in each of the outcomes assessed.…”

Section: Assessment Of Heterogeneitymentioning

confidence: 99%

Postoperative Analgesic Effectiveness of Quadratus Lumborum Block for Cesarean Delivery under Spinal Anesthesia

Hussain¹,

Brull²,

Weaver³

et al. 2020

Anesthesiology

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Background Spinal morphine is the mainstay of postcesarean analgesia. Quadratus lumborum block has recently been proposed as an adjunct or alternative to spinal morphine. The authors evaluated the analgesic effectiveness of quadratus lumborum block in cesarean delivery with and without spinal morphine. Methods Randomized trials evaluating quadratus lumborum block benefits in elective cesarean delivery under spinal anesthesia were sought. Three comparisons were considered: spinal morphine versus spinal morphine and quadratus lumborum block; spinal morphine versus quadratus lumborum block; and no block or spinal morphine versus quadratus lumborum block. The two coprimary outcomes were postoperative (1) 24-h cumulative oral morphine equivalent consumption and (2) pain at 4 to 6 h. Secondary outcomes included area under the curve pain, time to analgesic request, block complications, and opioid-related side effects. Results Twelve trials (924 patients) were analyzed. The mean differences (95% CIs) in 24-h morphine consumption and pain at 4 to 6 h for spinal morphine versus spinal morphine and quadratus lumborum block comparison were 0 mg (−2 to 1) and −0.1 cm (−0.7 to 0.4), respectively, indicating no benefit. For spinal morphine versus quadratus lumborum block, these differences were 7 mg (−2 to 15) and 0.6 cm (−0.7 to 1.8), respectively, also indicating no benefit. In contrast, for no block or spinal morphine versus quadratus lumborum block, improvements of −18 mg (−28 to −7) and −1.5 cm (−2.4 to −0.6) were observed, respectively, with quadratus lumborum block. Finally, for no block or spinal morphine versus quadratus lumborum block, quadratus lumborum block improved area under the 48-h pain curve by −4.4 cm · h (−5.0 to −3.8), exceeding the clinically important threshold (3.96 cm · h), but no differences were observed in the other comparisons. Conclusions Moderate quality evidence suggests that quadratus lumborum block does not enhance analgesic outcomes when combined with or compared with spinal morphine. However, the block improves postcesarean analgesia in the absence of spinal morphine. The clinical utility of this block seems limited to situations in which spinal morphine is not used. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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“…These measurements were used to calculate an overall three-dimensional (3D) distance between the closest point of the wire to where the drill bit passes through the posterior cortex of the humerus. This technique has previously been used to measure distances between structures radiologically [17]. Figure 2 shows the CT images of the drill bits and nerve marked with wire.…”

Section: Methodsmentioning

confidence: 99%

Proximity of Axillary Nerve During Cortical Button Repair of Pectoralis Major Tendon Rupture

et al. 2014

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Background Rupture of the pectoralis major (PM) tendon is a rare but severe injury. Several techniques have been described for PM fixation, including a transosseus technique, placing cortical buttons at the superior, middle and inferior PM tendon insertion points. The present cadaveric study investigates the proximity of the posterior branch of the axillary nerve to the drill positions for transosseus PM tendon repair. Methods Twelve cadaveric shoulders were used. The axillary nerve was marked during a preparatory dissection. Drills were passed through the humerus at the superior, middle and inferior insertions of the PM tendon and the drill bits were left in situ. The distance between these and each axillary nerve was measured using computed tomography. Results The superior drill position was in closest proximity to the axillary nerve (three-dimensional distance range 0-18.01 mm, mean 10.74 mm, 95% confidence interval 7.24 mm to 14.24 mm). The middle PM insertion point was also very close to the nerve. Conclusions Caution should be used when performing bicortical drilling of the humerus, especially when drilling at the superior border of the PM insertion. We describe 'safe' and 'danger' zones for the positioning of cortical buttons through the humerus reflecting the risk posed to the axillary nerve.

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Blockade of the Suprascapular Nerve: A Radiological and Cadaveric Study Comparing Landmark and Ultrasound-guided Blocking Techniques

Cited by 6 publications

References 10 publications

Proximity of the axillary nerve during bicortical drilling for biceps tenodesis

Proximity of the axillary nerve during bicortical drilling for biceps tenodesis

Postoperative Analgesic Effectiveness of Quadratus Lumborum Block for Cesarean Delivery under Spinal Anesthesia

Proximity of Axillary Nerve During Cortical Button Repair of Pectoralis Major Tendon Rupture

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