Ultrasound-Guided Suprascapular Nerve Block, Description of a Novel Supraclavicular Approach

Siegenthaler, Andreas; Moriggl, Bernhard; Mlekusch, Sabine; Schliessbach, Jürg; Haug, Matthias; Curatolo, Michele; Eichenberger, Urs

doi:10.1097/aap.0b013e3182409168

Cited by 114 publications

(81 citation statements)

References 8 publications

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“…First introduced in 1941,5 various safer modifications to the classic posterior approach to SSN block have been studied 21. USG anterior approach was described in 2012 14. A recent systematic review has challenged the accepted dominance of ISB over SSN for shoulder analgesia 1.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound-guided subomohyoid suprascapular nerve block and phrenic nerve involvement: a cadaveric dye study

Sehmbi

Johnson

Dhir

2019

Regional Anesthesia &Amp; Pain Medicine

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Backgrounds and objectivesThe anterior approach to the subomohyoid suprascapular (SOS) nerve is a new, technically easy and reliable regional anesthesia technique for postoperative shoulder analgesia. However, due to its proximity, the injectate may spread to the brachial plexus and phrenic nerve. The goal of this anatomic study with dye injection in the subomohyoid space and subsequent cadaver dissection was to establish the likely spread of local anesthesia and the extent of brachial plexus and phrenic nerve involvement resulting from ultrasound-guided SOS nerve block.MethodsThe suprascapular nerve (SSN) under the inferior belly of omohyoid muscle in the posterior triangle of the neck was identified. Using a contrast dye, 10 ultrasound-guided SOS nerve injections of 5 mL were done bilaterally, in five fresh cadavers. The area was then dissected to evaluate the spread of the contrast dye in the immediate proximity of the brachial plexus, phrenic and SSN.ResultsThe SSN and omohyoid muscle were easily identified on each cadaver. SOS nerve staining with contrast dye was seen in 90% of dissections. The superior trunk was stained in 90% and the middle trunk was stained in 80% of dissections. The inferior trunk was stained in 20% of dissections. A spread of dye around the SSN was observed in 90% and the phrenic nerve was mildly stained in 20% of the dissections.ConclusionIn-plane ultrasound-guided needle injection with a 5 mL volume for SOS block was sufficient to stain the SSN. This conservative volume involved other parts of the brachial plexus and may potentially spread to the phrenic nerve. Further clinical studies are required for confirmation.

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Section: Discussionmentioning

confidence: 99%

“…The SSN was identified under the inferior belly of omohyoid muscle in the supraclavicular area with the method described by Siegenthaler et al 14. Using an in-plane approach, a 50 mm, 22G insulated needle (Pajunk, Geisengen, Germany) was advanced in the lateral to medial direction in the supraclavicular area.…”

Section: Methodsmentioning

confidence: 99%

Ultrasound-guided subomohyoid suprascapular nerve block and phrenic nerve involvement: a cadaveric dye study

Sehmbi

Johnson

Dhir

2019

Regional Anesthesia &Amp; Pain Medicine

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“…The anterior approach is considered to be potentially harmful to the supraclavicular part of the brachial plexus due to its close anatomical proximity with the suprascapular nerve. In some cases, the block may even reach the brachial plexus 22. On the other hand, visualization of the suprascapular nerve might be problematic during the posterior approach.…”

Section: Discussionmentioning

confidence: 99%

“Pseudo-suprascapular notch”: is it a sonographic trap in suprascapular nerve block?

Podgórski

Rusinek

Cichosz

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesThe aim of the study was to describe the radiological anatomy of the pseudo-suprascapular notch—a structure localized at the floor of the supraspinatus fossa, just below the true suprascapular notch. In sonographic examination, it may imitate the suprascapular notch leading to misidentification of these structures.MethodsUltrasound assessment of the suprascapular notch region was performed in 100 patients who underwent chest CT due to other indications. The presence of the suprascapular notch and the pseudo-suprascapular notch was evaluated together with their maximal width and depth using both techniques. The correlation between the dimensions of these two notches was assessed.ResultsThe pseudo-suprascapular notch was recognized in 82 patients. In four of them the suprascapular notch could not be visualized in ultrasound due to obscuring clavicle. In all cases the pseudo-suprascapular notch contained a small artery. In comparison to the suprascapular notch, the pseudo-suprascapular notch was significantly narrower and shallower, except for 10 cases with vestigial suprascapular notch where the pseudo-suprascapular notch was the only hollow in this region. The dimensions of both structures did not correlate with each other. Finally, the pseudo-suprascapular notch did not present any significant asymmetry (p=0.1185) or sexual dimorphism (43 women vs 38 men, p=0.2025).ConclusionsThe pseudo-suprascapular notch is a hollow for nutrient vessels that can be mistaken for the regular suprascapular notch in cases of difficult sonographic navigation.

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“…[24][25][26] However, if fluoroscopic technique is used frequently, it can cause serious health problems because of exposure to radiation. Fluoroscopy is not preferred to SSNB in rehabilitation practice.…”

Section: Discussionmentioning

confidence: 99%

“…[25][26][27] USG is simple to use and had no irradiation. As such, USG guided SSNB has become more popular among physicians.…”

Section: Discussionmentioning

confidence: 99%

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

Külcü¹,

Taraktaş²,

Badur³

et al. 2017

Turk J Phys Med Rehab

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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...

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Ultrasound-Guided Suprascapular Nerve Block, Description of a Novel Supraclavicular Approach

Abstract: Visualization of the SSN with US is better in the supraclavicular region as compared with the supraspinous fossa. The anatomic dissections confirmed that our novel supraclavicular SSN block technique is accurate.

Cited by 114 publications

References 8 publications

Ultrasound-guided subomohyoid suprascapular nerve block and phrenic nerve involvement: a cadaveric dye study

Ultrasound-guided subomohyoid suprascapular nerve block and phrenic nerve involvement: a cadaveric dye study

“Pseudo-suprascapular notch”: is it a sonographic trap in suprascapular nerve block?

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

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