Anterior Suprascapular Nerve Block Versus Interscalene Brachial Plexus Block for Shoulder Surgery in the Outpatient Setting

Wiegel, Martin; Moriggl, Bernhard; Schwarzkopf, Peter; Petroff, David; Reske, Andreas W.

doi:10.1097/aap.0000000000000573

Cited by 70 publications

(62 citation statements)

References 25 publications

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“…Ten millilitres is a high volume and there is likely to have been local anaesthetic spread to the phrenic nerve with this volume. Nevertheless, it corresponds with the literature regarding suprascapular nerve blocks . Further studies using lower volume (e.g.…”

Section: Discussionsupporting

confidence: 85%

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Hemidiaphragmatic paralysis following ultrasound‐guided anterior vs. posterior suprascapular nerve block: a double‐blind, randomised control trial

et al. 2020

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Summary Interscalene brachial plexus block provides analgesia for shoulder surgery but is associated with hemidiaphragmatic paralysis. Before considering a combined suprascapular and axillary nerve block as an alternative to interscalene brachial plexus block, evaluation of the incidence of diaphragmatic dysfunction according to the approach to the suprascapular nerve is necessary. We randomly allocated 84 patients undergoing arthroscopic shoulder surgery to an anterior or a posterior approach to the suprascapular nerve block combined with an axillary nerve block using 10 ml ropivacaine 0.375% for each nerve. The primary outcome was the incidence of hemidiaphragmatic paralysis diagnosed by ultrasound. Secondary outcomes included: characterisation of the hemidiaphragmatic paralysis over time; numeric rating scale pain scores; oral morphine equivalent consumption; and patient satisfaction. The incidence of hemidiaphragmatic paralysis was 40% (n = 17) vs. 2% (n = 1) in the anterior and posterior groups, respectively (p < 0.001). In one third of patients with hemidiaphragmatic paralysis, it persisted beyond the eighth hour. The median (interquartile range [range]) oral morphine equivalent consumption was significantly higher in the posterior approach when compared with the anterior approach, whether in the recovery area (20 [5–31 (0–60)] mg vs. 7.5 [0–14 (0–52)] mg, respectively; p = 0.004) or during the first 24 h (82 [61–127 (12–360) mg] vs. 58 [30–86 (0–160)] mg, respectively; p = 0.01). Patient satisfaction was comparable between groups (p = 0.6). Compared with the anterior approach, diaphragmatic function is best preserved with the posterior needle approach to the suprascapular nerve block.

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Section: Discussionsupporting

confidence: 85%

“…The suprascapular and axillary nerves provide sensory innervation to most of the glenohumeral joint [14][15][16]. Therefore, a combined suprascapular and axillary nerve block is a valid alternative to interscalene brachial plexus block [4] with less impact on respiratory function [17][18][19][20][21][22] and hand-grip strength [23].…”

Section: Introductionmentioning

confidence: 99%

Hemidiaphragmatic paralysis following ultrasound‐guided anterior vs. posterior suprascapular nerve block: a double‐blind, randomised control trial

et al. 2020

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“…Beside axillary/suprascapular 2,3 and infraclavicular/suprascapular nerve blocks, 4 proposed strategies also include isolated suprascapular nerve blocks. 19,20 Although recent trials by Wiegel et al 19 and Auyong et al 20 have concluded that suprascapular blocks result in similar analgesia to ISB for arthroscopic shoulder surgery 19 and shoulder arthroplasty, 20 other studies seem to suggest that they provide suboptimal analgesia. 21,22 Because the shoulder also receives sensory innervation from the axillary, lateral pectoral, and subscapular nerves, 1 we decided to err on the side of caution and attempted to find an alternative to ISB that would anesthetize all these nerves.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Comparison Between Interscalene and Small-Volume Supraclavicular Blocks for Arthroscopic Shoulder Surgery

Aliste

Fernández

Layera

et al. 2018

Regional Anesthesia and Pain Medicine

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“…It has been modified multiple times, is technically challenging and has shown conflicting results 8. The anterior approach (in the supraclavicular fossa) has been recently proposed as a reliable and easy technique9 with similar efficacy for shoulder surgery 10. However, the proximity to the brachial plexus in this region may result in a potential extension of local anesthetic to the phrenic nerve if conventional large volumes are used.…”

Section: Introductionmentioning

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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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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Anterior Suprascapular Nerve Block Versus Interscalene Brachial Plexus Block for Shoulder Surgery in the Outpatient Setting

Abstract: For outpatients undergoing arthroscopic shoulder surgery under general anesthesia, the SSNB seems preferable to ISB. It provides excellent postoperative analgesia without exposing patients to impaired mobility and to risks of the more potent but also more invasive ISB.

Cited by 70 publications

References 25 publications

Hemidiaphragmatic paralysis following ultrasound‐guided anterior vs. posterior suprascapular nerve block: a double‐blind, randomised control trial

Hemidiaphragmatic paralysis following ultrasound‐guided anterior vs. posterior suprascapular nerve block: a double‐blind, randomised control trial

A Randomized Comparison Between Interscalene and Small-Volume Supraclavicular Blocks for Arthroscopic Shoulder Surgery

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

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