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The use of localized direct nerve blocks for anesthesia instead of pre‐operative anesthetic procedures based on intubation has shown greater successful surgical outcomes. Peripheral nerve blocks have been used to achieve local anesthesia but the risk of direct puncture of the nerve has been documented. This study utilized ultrasound on donor bodies to visualize the suprascapular nerve and to safely guide the “anesthetic” saturation delivery to the surrounding tissue without damaging the nerve (n=14). Using a 5–2 MHz transducer placed the sagittal plane, the scapular spine was visualized. The ultrasound transducer was then placed in a transverse orientation to the scapular spine. Moving the transducer superior from the scapular spine, the suprascapular notch was visualized in the supraspinatous fossa. Real‐time imaging was used for injection of methyl blue via a 20 gauge syringe into the suprascapular notch. During real‐time clinical application of this technique, the suprascapular artery could be visualized and avoided by utilizing ultrasound color‐flow. Dissection of the donor shoulder region was then completed to confirm accurate dispensation of the methyl blue to the suprascapular nerve confirming the technique to be viable. Advantages of using ultrasound guidance for this technique include limiting radiation exposure to the patient, being cost‐effective compared with general anesthesia protocols, and having clinical applications in chronic and acute pain management including osteoarthritis of the glenohumeral joint.

FIG. 1. Ocular motility examination of left oculomotor nerve palsy. The left eye displays exotropia in primary gaze and adduction, upgaze and downgaze deficits, and full abduction.