Selective Suprascapular and Axillary Nerve Block Provides Adequate Analgesia and Minimal Motor Block. Comparison with Interscalene Block

Pitombo, Patrícia Falcão; Barros, Rogério Meira; Matos, Marcos Almeida; Módolo, Norma Sueli Pinheiro

doi:10.1016/j.bjane.2012.04.002

Cited by 8 publications

(10 citation statements)

References 17 publications

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“…Thus, ISB is not suitable for patients with chronic respiratory diseases such as chronic obstructive pulmonary disease or diffuse parenchymal lung disease (see Introduction, Verelst and van Zundert, ). Multiple studies have reported a wide range of outcomes of the combined approach (Price et al, ; Pitombo et al, ; Dhir et al, ; Neuts et al, ). Early‐stage analgesic success seems to be lower for this technique than for ISB (Pitombo et al, ; Dhir et al, ; Neuts et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have reported a wide range of outcomes of the combined approach (Price et al, ; Pitombo et al, ; Dhir et al, ; Neuts et al, ). Early‐stage analgesic success seems to be lower for this technique than for ISB (Pitombo et al, ; Dhir et al, ; Neuts et al, ). Moreover, most of these studies show incomplete blockade of both SSN and AN, a percentage that can rise to 41.4% (Dhir et al, ) even in US‐guided procedures.…”

Section: Discussionmentioning

confidence: 99%

“…In many cases, the nerve branch innervating the shoulder joint (called the joint nerve—JN—by some authors) arises directly from the main nerve in the first segment adjacent to the SSM (Duparc et al, ). This pattern, with early detachment of the JN from the AN, could imply that a posterior injection approach, like the one usually employed for the AN blockade (Rothe et al, ; Pitombo et al, ; Dhir et al, ; Neuts et al, ), reaches the AN after fibers directed toward the articular capsule leave the main nerve, which would result in incomplete anesthesia. In fact, failure rates for posterior blockades have been reported to be as high as 41.4% (Dhir et al, ).…”

Section: Introduction and Aimsmentioning

confidence: 99%

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Ultrasonography‐guided anterior approach for axillary nerve blockade: An anatomical study

et al. 2019

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Combined ultrasound (US)-guided blockade of the suprascapular and axillary nerves (ANs) has been proposed as an alternative to interscalene blockade for pain control in shoulder joint pathology or postsurgical care. This technique could help avoid respiratory complications and/or almost total upper limb palsy. Nowadays, the AN blockade is mostly performed using an in-plane caudal-to-cephalic approach from the posterior surface of the shoulder, reaching the nerve immediately after it exits the neurovascular quadrangular space (part of the spatium axillare). Despite precluding most respiratory complications, this approach has not made postsurgical pain relief any better than an interscalene blockade, probably because articular branches of the AN are not blocked.Cephalic-to-caudal methylene blue injections were placed in the first segment of the AN of six Thiel-embalmed cadavers using an US-guided anterior approach in order to compare the distribution with that produced by a posterior approach to the contralateral AN in the same cadaver. Another 21 formalin-fixed cadavers were bilaterally dissected to identify the articular branches of the AN.We found a good spread of the dye on the AN and a constant relationship of this nerve with the subscapularis muscle. The dye reached the musculocutaneous nerve, which also contributes to shoulder joint innervation. We describe the anatomical landmarks for an ultrasonography-guided anterior AN blockade and hypothesize that this anterior approach will provide better pain control than the posterior approach owing to complete blocking of the joint nerve. Clin. Anat. 33:488-499, 2020.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introduction and Aimsmentioning

confidence: 99%

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Ultrasonography‐guided anterior approach for axillary nerve blockade: An anatomical study

et al. 2019

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“…In terms of alleviating shoulder pain, the suprascapular nerve block has been considered a comparable alternative to the interscalene brachial plexus block. Notably, the latter increases the risk of injection into the epidural space and complications such as spinal cord and brachial plexus injuries and pneumothorax 10 . The suprascapular nerve block has been proven to be efficacious for postarthroscopic analgesia, 11 pain control after thoracotomy, 12 and treatment of painful shoulder arthritis and adhesive capsulitis 13 , 14 .…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‐Guided Proximal Suprascapular Nerve Block With Radiofrequency Lesioning for Patients With Malignancy‐Associated Recalcitrant Shoulder Pain

Chang

Hung

Wang

et al. 2015

J of Ultrasound Medicine

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The classic suprascapular nerve block has limitations, such as postural requirements and lack of direct nerve visualization. This series investigated the analgesic effect of ultrasound-guided supraclavicular suprascapular nerve blocks in patients with malignancy-associated shoulder pain. Ablative radiofrequency lesioning of the suprascapular nerve in 6 patients provided substantial pain relief. The mean distance from the suprascapular nerve to the brachial plexus was 8.05 mm, and the mean angle of needle entry was 20.6°. This approach appears to be effective in relieving malignancy-associated shoulder pain and is tolerated by patients unable to sit or lie prone.

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“…However, other nerves contribute as well . Few studies have examined the use of a selective block of the suprascapular nerve – alone or in combination with an axillary nerve block – for arthroscopic shoulder surgery, and the results are ambiguous .…”

Section: Introductionmentioning

confidence: 99%

Effect of a lateral infraclavicular brachial plexus block on the axillary and suprascapular nerves as determined by electromyography – a cohort study

et al. 2018

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We aimed to examine to what extent a lateral infraclavicular brachial plexus block affected the axillary and the suprascapular nerve. We included patients undergoing hand surgery anaesthetised with a lateral infraclavicular brachial plexus block. Our primary outcome was the relative change in surface electromyography during maximum voluntary isometric contraction of the medial deltoid muscle (axillary nerve) and the infraspinatus muscle (suprascapular nerve) from baseline to 30 min after the block procedure. A reduction in electromyography of > 50% defined a successful block. The impact of the block on the shoulder nerves was compared with the surgical target nerves of the arm and hand (musculocutaneous, radial, median and ulnar nerves). Twenty patients were included. The medians of the relative changes in the surface electromyography were significantly reduced (both p< 0.001) with 92% for the deltoid muscle and 30% for the infraspinatus muscle, respectively. In total, 18 out of 20 patients had reductions > 50% for the deltoid muscle, which was significantly different from the infraspinatus muscle, where the proportion was 5 out of 20 (p < 0.001). The medians of the relative reductions in electromyography for the arm and hand muscles were 90-96%, similar to the effect on the deltoid muscle. Our results suggest that a lateral infraclavicular block provides block of the axillary nerve comparable to the block of the surgical target nerves. The suprascapular nerve is blocked to a lesser degree. Combining a lateral infraclavicular brachial plexus block with a selective suprascapular block for shoulder surgery warrants further studies.

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Selective Suprascapular and Axillary Nerve Block Provides Adequate Analgesia and Minimal Motor Block. Comparison with Interscalene Block

Cited by 8 publications

References 17 publications

Ultrasonography‐guided anterior approach for axillary nerve blockade: An anatomical study

Ultrasonography‐guided anterior approach for axillary nerve blockade: An anatomical study

Ultrasound‐Guided Proximal Suprascapular Nerve Block With Radiofrequency Lesioning for Patients With Malignancy‐Associated Recalcitrant Shoulder Pain

Effect of a lateral infraclavicular brachial plexus block on the axillary and suprascapular nerves as determined by electromyography – a cohort study

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