Subscapularis and sub-omohyoid plane blocks: an alternative to peripheral nerve blocks for shoulder analgesia

In Pursuit of Phrenic Nerve-Sparing Regional Anesthesia For Awake Shoulder Manipulation In Patients With Adhesive Capsulitis

“…The clinical finding from Sondekoppam et al, (7) precisely explained in the cadaveric study of Drake et al, (14) showed that a This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License specific volume of dye being injected at the subscapularis plane might stain axillary and subscapular nerves. A similar result was also achieved by injecting dye deep to subscapularis muscle, staining more distal branches of nerves in the vicinity of the shoulder capsule (15).…”

“…Until recently, apart from interscalene brachial plexus block, studies on complete shoulder regional anesthesia approaches have been mainly focusing on superior trunk (C5-6) block, suprascapular nerve block, and selective nerves block (7,11,12). While superior trunk and suprascapular nerve blocks' sensory coverage are self-explanatory, the selective nerves block covers three different nerves and/or plane blocks; subscapular plane block targeting subscapular and axillary nerves, suprascapular nerve block, and PECS-1 block for the lateral pectoral nerve (7).…”

“…Any shortcoming of the previous approach was discovered by incorporating additional axillary and subscapular nerve blockade, first described in correspondence by Sondekoppam et al, who applied the shoulder interfascial plane block technique with or without PECS-1 (for the lateral pectoral nerve) for analgesia of shoulder surgeries in high-risk patients. Taking advantage of the relevant anatomical position of both nerves that lie in the common potential plane, subscapularis plane, Sondekoppam et al deposited local anesthetic at the said plane, directly beneath the epimysium of the subscapularis muscle (7).…”

“…While the technique of shoulder interfascial plane block has been proven effective as part of analgesia in shoulder surgeries, the author still found that the patient frowned during external rotation at zero degree abduction of the shoulder and sensed muscle resistance, both originating from the subscapularis muscle, with significant palpable trigger points at the superior and inferior lateral aspects on the ventral surface of the subscapularis muscle belly (7).…”

“…Lately, however, some literature has offered superior trunk block, suprascapular nerve block, and shoulder interfascial plane block each as the sole anesthetic technique for shoulder procedures while sparing the phrenic nerve function (7,8). Yet, none of the comparisons between them has focused on shoulder manipulation for adhesive capsulitis.…”