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Correspondence Suprascapular nerve block in the management of cancer painWe read with interest the article by Wassef describing the use of suprascapular nerve block in the management of frozen shoulder (Anaesthesia 1992; 47: 120-4). The use of this block for cancer pain has not been reported previously and we would like to describe its use in the management of shoulder pain due to a solitary metastasis from breast cancer.A 39-year-old woman presented to the Pain Clinic with a 9 month history of pain in the left shoulder. She had undergone a right partial mastectomy for carcinoma of the breast 21 months previously. A local recurrence had subsequently been successfully treated by radiotherapy.

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and sore throat that developed after general anaesthesia for minor gynaecological surgery, of less than 10 min duration, in almost 900 patients who had given informed consent [2]. Patients were allocated randomly to two groups. One group received suxamethonium 1 mg kg" 1 after induction of anaesthesia and underwent manual ventilation of the lungs with nitrous oxide via face mask. The other group breathed nitrous oxide spontaneously and anaesthesia was maintained with increments of the chosen induction agent. Tracheal rubes were not used and Guedel airways inserted only in a small number of patients (4%) with difficult airways; these were excluded from further analysis. Whilst the overall incidence of suxamethonium pains in 407 patients was found to be 52 %, the incidence of sore throat in this group was 19 %, compared with 3.2 % in the non-paralysed group (P > 0.001). In 81 % of the patients with sore throat following suxamethonium, typical muscle pains also developed, usually involving neck pain or stiffness as a major component (85 %). It is difficult to attribute the sore throat to any other factor, unless the brief period of intermittent positive pressure ventilation exerted some effect on the pharynx or larynx. Thus it does appear as if sore throat is another manifestation of suxamethonium pains, presumably because of action of the agent on the muscle spindles of the laryngeal or pharyngeal muscles, although this has not been demonstrated [2]. As Deacock pointed out [1], suxamethonium must be taken into account when postoperative sore throat is assessed and this depolarizing agent has been used.