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/s0034-7094(13)70197-1

Cited by 45 publications

(33 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nonetheless, 2 RCTs (combined n = 129) set out to compare ISB and combined AXB-SSB in patients undergoing arthroscopic shoulder surgery (mainly rotator cuff repair) under general anesthesia. 55,56 The results of both trials confirmed Checcucci and colleagues' and Price's suspicion. Compared with ISB, AXB-SSB resulted in higher intraoperative opioid requirements, 56 increased pain/opioid consumption in the postanesthesia care unit, 55,56 and decreased patient satisfaction at 6 hours.…”

Section: Distal Nerve Blocks For Shoulder Surgerysupporting

confidence: 70%

“…55,56 The results of both trials confirmed Checcucci and colleagues' and Price's suspicion. Compared with ISB, AXB-SSB resulted in higher intraoperative opioid requirements, 56 increased pain/opioid consumption in the postanesthesia care unit, 55,56 and decreased patient satisfaction at 6 hours. 56 However, analgesic duration was longer, and pain scores were lower at 24 hours with AXB-SSB.…”

Section: Distal Nerve Blocks For Shoulder Surgerysupporting

confidence: 70%

See 1 more Smart Citation

Diaphragm-Sparing Nerve Blocks for Shoulder Surgery

Tran

Elgueta

Aliste

et al. 2017

Regional Anesthesia and Pain Medicine

175

View full text Add to dashboard Cite

Shoulder surgery can result in significant postoperative pain. Interscalene brachial plexus blocks (ISBs) constitute the current criterion standard for analgesia but may be contraindicated in patients with pulmonary pathology due to the inherent risk of phrenic nerve block and symptomatic hemidiaphragmatic paralysis. Although ultrasound-guided ISB with small volumes (5 mL), dilute local anesthetic (LA) concentrations, and LA injection 4 mm lateral to the brachial plexus have been shown to reduce the risk of phrenic nerve block, no single intervention can decrease its incidence below 20%. Ultrasound-guided supraclavicular blocks with LA injection posterolateral to the brachial plexus may anesthetize the shoulder without incidental diaphragmatic dysfunction, but further confirmatory trials are required. Ultrasound-guided C7 root blocks also seem to offer an attractive, diaphragm-sparing alternative to ISB. However, additional large-scale studies are needed to confirm their efficacy and to quantify the risk of periforaminal vascular breach. Combined axillary-suprascapular nerve blocks may provide adequate postoperative analgesia for minor shoulder surgery but do not compare favorably to ISB for major surgical procedures. One intriguing solution lies in the combined use of infraclavicular brachial plexus blocks and suprascapular nerve blocks. Theoretically, the infraclavicular approach targets the posterior and lateral cords, thus anesthetizing the axillary nerve (which supplies the anterior and posterior shoulder joint), as well as the subscapular and lateral pectoral nerves (both of which supply the anterior shoulder joint), whereas the suprascapular nerve block anesthetizes the posterior shoulder. Future randomized trials are required to validate the efficacy of combined infraclavicular-suprascapular blocks for shoulder surgery.

show abstract

Section: Distal Nerve Blocks For Shoulder Surgerysupporting

confidence: 70%

Section: Distal Nerve Blocks For Shoulder Surgerysupporting

confidence: 70%

Diaphragm-Sparing Nerve Blocks for Shoulder Surgery

Tran

Elgueta

Aliste

et al. 2017

Regional Anesthesia and Pain Medicine

175

View full text Add to dashboard Cite

show abstract

“…These differences could be attributed to lower rate of incomplete SSN and AN blocks found in our study (18.7% and 25%, respectively) compared with Dhir and colleagues' trial 14 (39.3% and 41.4%, respectively). Pitombo and colleagues' 12 and Dhir and colleagues' 14 trials have also found SSB to be the more effective analgesic technique at 24 hours. However, our study does not support this conclusion because pain levels were similar at 24 hours in the 2 study groups, and opioid consumption was comparable between 12 and 24 hours.…”

Section: Discussionmentioning

confidence: 96%

“…Eligibility criteria in the current study were similar to those used by other trials that established efficacy of the reference treatment. [12][13][14] Using a computer-generated random allocation sequence (created by the study statistician), patients were randomly assigned to ultrasound-guided SSB (n = 50) or ISB (n = 50). Allocation numbers were sealed in opaque envelopes, which were opened in sequence by an independent anesthesiologist who was not involved in the assessment of outcomes.…”

Section: Methodsmentioning

confidence: 99%

Selective Suprascapular and Axillary Nerve Block Versus Interscalene Plexus Block for Pain Control After Arthroscopic Shoulder Surgery

Neuts

Stessel

Wouters

et al. 2018

Regional Anesthesia and Pain Medicine

View full text Add to dashboard Cite

show abstract

“…The classic posterior approach to the nerve was first introduced in 1941 5. This approach to the SSN (in the supraspinatus fossa) proposed as an alternative analgesic block while preserving phrenic nerve function6 can be associated with higher technical failures 7. It has been modified multiple times, is technically challenging and has shown conflicting results 8.…”

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

View full text Add to dashboard Cite

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.

show abstract

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

Abstract: Both techniques are safe, effective, and with the same degree of satisfaction and acceptability. The selective blockade of both nerves showed satisfactory analgesia, with the advantage of providing motor block restricted to the shoulder.

Cited by 45 publications

References 17 publications

Diaphragm-Sparing Nerve Blocks for Shoulder Surgery

Diaphragm-Sparing Nerve Blocks for Shoulder Surgery

Selective Suprascapular and Axillary Nerve Block Versus Interscalene Plexus Block for Pain Control After Arthroscopic Shoulder Surgery

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

Contact Info

Product

Resources

About