Ultrasound-Guided Versus Landmark-Based Approach to the Distal Suprascapular Nerve Block: A Comparative Cadaveric Study

Laumonerie, Pierre; Blasco, Laurent; Tibbo, Meagan E.; Kerezoudis, Panagiotis; Fernandes, Olivier; Lauwers, F.; Bonnevialle, Nicolas; Mansat, Pierre; Ohl, Xavier

doi:10.1016/j.arthro.2019.02.050

Cited by 14 publications

(12 citation statements)

References 20 publications

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“…Although there are many studies that report favorable clinical outcomes, there are very limited data that evaluate the anatomic accuracy and safety of these injections. 14 This study demonstrates that a surgeon performed field injection accurately reaches the desired tissues and nerves that are responsible for postoperative pain after shoulder surgery without risk for intraarticular joint injection. Although methylene blue staining seems to be relatively simple methodology, it remains the gold standard in assessing accuracy after injection.…”

Section: Discussionmentioning

confidence: 68%

“…Although methylene blue staining seems to be relatively simple methodology, it remains the gold standard in assessing accuracy after injection. 14 , 15 This may be a useful alternative for local-regional anesthesia when ISB is undesirable or not available.…”

Section: Discussionmentioning

confidence: 99%

“… 18 A second concern is that the staining of tissues with methylene blue may appear simplistic. Nonetheless, this methodology remains the gold standard in the reported literature, highlighted by Laumonerie et al's 2019 study 14 on the accuracy of the ultrasound-guided injection of the suprascapular nerve. We state that no intraneural injection occurred, in theory injection is best evaluated with histologic section of the nerves; nonetheless, we are not aware of any studies in which this was performed.…”

Section: Discussionmentioning

confidence: 99%

“…In accordance with previous studies examining the efficacy of a nerve block, 14 , 15 a solution consisting of 20 mL of liposomal bupivacaine, 40 mL of normal saline, and 5 drops of methylene blue was prepared. Landmarks of the triangular field were determined and marked based on an infiltration technique as shown in Figure 1 .…”

Section: Methodsmentioning

confidence: 99%

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Determining anatomic accuracy of shoulder field injection: triangular injection technique does adequately reach pain transmitters

Sheth¹

2020

JSES International

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Background Controlling pain after shoulder surgery is a critical component of postsurgical care. Several recent studies have described the use of periarticular, local infiltration anesthesia, and field blocks (FBs) with clinical efficacy after shoulder surgery. The anatomic accuracy and safety of these FBs have not been well described. The purpose of this study was to determine the accuracy of a surgeon performed shoulder field injection. We hypothesized that our field injection would adequately reach the pain transmitters responsible for postsurgical shoulder pain. Methods A total of 10 cadaveric specimens were used in the study. A mixture of liposomal bupivacaine, normal saline, and methylene blue totaling 60 cc was prepared. After injection, the specimens were left for 4 hours to allow medication diffusion. The dissection of specimens was performed to identify 4 areas: axillary nerve, suprascapular nerve, supraclavicular nerves, and joint capsule. On dissection, accuracy rates were determined for each area. Results All 10 cadaveric specimens were injected and dissected to completion. The dissection of the axillary nerve showed methylene blue dye surrounding the nerve in 10 of 10 (100%) specimens, the suprascapular nerve in 9 of 10 (90%), and the supraclavicular nerves in 10 of 10 (100%). Zero of 10 (0%) specimens had any dye penetrate into the glenohumeral joint or capsule. Conclusion The accuracy rates of the injection of the mixture into the shoulder specimens suggest potential to reproduce an FB to the tissues that are responsible for postoperative pain after shoulder surgery. This may represent an option when interscalene nerve block is not desired or contraindicated.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Determining anatomic accuracy of shoulder field injection: triangular injection technique does adequately reach pain transmitters

Sheth¹

2020

JSES International

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“…Additionally, 28% of patients in the group receiving ISB alone required an opioid refill, as compared with no patients in the group receiving the additional anesthesia with the field block. The sensory branches of the suprascapular nerve originate adjacent to the suprascapular notch and then travel along the base of the coracoid process to distribute to the shoulder structures [11, 14]. It was proposed that an effective and safe sensory-only block can be performed if the needle is directed to that point using external landmarks [11, 14].…”

Section: Discussionmentioning

confidence: 99%

Surgeon-Administered Nerve Block During Rotator Cuff Repair Can Promote Recovery with Little or No Post-operative Opioid Use

Caldwell

Selepec

2020

HSS Jrnl

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Background: The use of opioid analgesia is common in both the acute and extended post-operative periods after rotator cuff repair. The current opioid crisis has prompted surgeons to seek alternatives that minimize or even eliminate the need for oral opioids after surgery. Questions/Purposes: We sought to investigate the effects on post-operative opioid use of a surgeon-administered block of the suprascapular and axillary nerves in arthroscopic rotator cuff repair (ARCR), in particular to quantify outpatient opioid consumption and duration. Methods: In this prospective observational study, all patients undergoing primary ARCR performed under general anesthesia by a single surgeon were studied over a 15-month period. Of 91 ARCRs performed, 87 patients were enrolled and followed prospectively. At the conclusion of the procedure, the surgeon performed "local-regional" nerve blockade with injections to the sensory branches of the suprascapular nerve and the axillary nerve, as well as local infiltration about the shoulder. Use of medications in the post-anesthesia care unit was left up to the anesthesiologist. Patients were prescribed oral opioids (hydrocodone/acetaminophen 5/325 mg) for analgesia after discharge. The quantity and duration of opioid use and pain scores were recorded for 4 months. Statistical analysis was performed to evaluate factors that could account for greater opioid use. Results: Total opioid consumption ranged from 0 to 30 opioid tablets (average, 4.2 tablets) over the 4month period. Post-operatively, 91% of patients took between ten or fewer tablets, and 39% took no opioids. The average duration of opioid use was 2.4 days. No patients were taking opioids at the 4-to 6-week or 4-month follow-up visits, none required refills, and none received prescriptions from outside prescribers. No statistically significant differences were seen in opioids taken or duration of use in regard to tear size, sex, body mass index, surgery location, or procedure time. There was a significant inverse correlation between opioid use and age. In addition, the cost of the surgeon-performed procedure was substantially lower than that associated with pre-operative nerve blockade performed by an anesthesiologist. All patients were satisfied with the post-operative pain management protocol. Average reported post-operative pain scores were low and decreased at each visit. Conclusion: With this localregional nerve-blocking protocol, opioid use after ARCR was unexpectedly low, and a large proportion of patients recovered without any post-surgical opioids. The correlation seen between opioid use and age may not be clinically significant, given the low use of post-operative opioids overall. These results may be useful in guiding post-operative opioid prescribing after ARCR, as well as in lowering costs associated with ARCR.

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Ultrasound‐Guided Suprascapular Nerve Block at Suprascapular Notch‐Do We Really Target Suprascapular Notch or Not? Where Is Our Real Target?

Keles

Özkan

Giray

et al. 2023

J of Ultrasound Medicine

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Ultrasound (US)‐guided suprascapular nerve block (SSNB) is a widely used procedure and while describing the US‐guided SSNB in the suprascapular notch, the suprascapular fossa is often visualized and injection is performed in that location. Although it can be done in both location, to inject the right area, the terminology should be settled and the visualization of these areas which are unclear and confusing in the literature should be clarified. In this sense, we showed the course of the nerve on a cadaver and briefly describe a protocol to correctly visualize the suprascapular notch with US.

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Ultrasound-Guided Versus Landmark-Based Approach to the Distal Suprascapular Nerve Block: A Comparative Cadaveric Study

Cited by 14 publications

References 20 publications

Determining anatomic accuracy of shoulder field injection: triangular injection technique does adequately reach pain transmitters

Determining anatomic accuracy of shoulder field injection: triangular injection technique does adequately reach pain transmitters

Surgeon-Administered Nerve Block During Rotator Cuff Repair Can Promote Recovery with Little or No Post-operative Opioid Use

Ultrasound‐Guided Suprascapular Nerve Block at Suprascapular Notch‐Do We Really Target Suprascapular Notch or Not? Where Is Our Real Target?

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