A new technique for regional anesthesia for arthroscopic shoulder surgery based on a suprascapular nerve block and an axillary nerve block: An evaluation of the first results
ABSTRACT We propose a new technique of regional anesthesia that combines suprascapular nerve block (SSNB) and axillary nerve block (ANB) in arthroscopic shoulder surgery.
Twenty consecutive patients undergoing arthroscopic procedures for shoulder cuff diseases were included in the trial. SSNB was performed by introducing the stimulating needle approximately 2 cm medial to the medial border of the acromion and about 2 cm cranial to the superior margin of the scapular spine until supraspinatus or infraspinatus muscle contractions were elicited. Following negative aspiration, 15 mL of a mixture of 2% lidocaine (5 mL) and 0.5% levobupivacaine (10 mL) was injected. ANB was performed; a line was drawn between the lateral-posterior angle of the acromion and the olecranon tip of the elbow. The location was about 2 cm cranial to the convergence of this line with the perpendicular line from the axillary fold. The needle was introduced approximately 2 cm cranial to this crossing point to elicit deltoid muscle contractions, and another 15 mL of the same anesthetic mixture was injected. Five mL of the same mixture was injected into each portal of the arthroscopic area. During surgery, patients were sedated with the use of midazolam. General anesthesia was not performed. Acceptance of the technique was assessed through a postsurgical survey of those treated.
No serious complications occurred. None of the patients required opiates, analgesics, or general anesthesia during the surgical procedure. Postoperative pain control, which was assessed using a visual analog scale, was effective during the observation time. The total demand for nonopiate analgesics during the first 24 postoperative hours was negligible. Patient satisfaction and comfort were satisfactory.
Combining SSNB and ANB is an effective and safe technique for intraoperative anesthesia and postoperative analgesia for certain procedures of shoulder arthroscopic surgery.
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ABSTRACT: Axillary nerve block (ANB) was recently introduced along with suprascapular nerve block as an alternative to inter-scalene brachial plexus block for post-operative pain control. However, the methods for performing ANB are variable. We studied the relationship between surface anatomy and the location of the axillary nerve in the quadrilateral space to ensure a technically safe and simple ANB. Eighty-eight shoulders were included. All measurements were performed with the subjects seated and the shoulders in a neutral position. We located the posterior circumflex humeral artery (PCHA) using a vascular Doppler system and named this point 'AN'. We used this point to locate the axillary nerve, since this nerve is generally present with the PCHA in the quadrilateral space. We then examined the relationship between surface anatomic landmarks and AN. The depth of the medial side of the humerus at the AN (AN depth), which is at the lateral border of the quadrilateral space, was measured using ultrasonography. AN was located on the line between the posterolateral corner of the acromion (Ac) and the axillary fold (Axf) (Ac-Axf) in 77% of shoulders. The ratio of the distance from Ac to AN (Ac-AN) to Ac-Axf in all shoulders was 0.6 [standard deviation (SD), 0.1]. AN depth was 4.0 (SD, 0.5) cm in men and 3.6 (SD, 0.4) cm in women. Knowledge of the relationship between surface anatomy and AN, as well as estimated AN depth may aid in locating the axillary nerve in the quadrilateral space.Acta Anaesthesiologica Scandinavica 03/2014; 58(5). DOI:10.1111/aas.12294 · 2.31 Impact Factor
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ABSTRACT: The aim of this study was to evaluate effect of pulsed radiofrequency (PRF) neuromodulation of suprascpaular nerve (SSN) in patients with chronic shoulder pain due to adhesive capsulitis and/or rotator cuff tear. The study included 11 patients suffering from chronic shoulder pain for at least 6 months who were diagnosed with adhesive capsulitis (n=4), rotator cuff tear (n=5), or adhesive capsulitis+rotator cuff tear (n=2) using shoulder magnetic resonance imaging or extremity ultrasonography. After a favorable response to a diagnostic suprascapular nerve block twice a week (pain improvement >50%), PRF neuromodulation was performed. Shoulder pain and quality of life were assessed using a Visual Analogue Scale (VAS) and the Oxford Shoulder Score (OSS) before the diagnostic block and every month after PRF neuromodulation over a 9-month period. The mean VAS score of 11 patients before PRF was 6.4±1.49, and the scores at 6-month and 9 month follow-up were 1.0±0.73 and 1.5±1.23, respectively. A significant pain reduction (p<0.001) was observed. The mean OSS score of 11 patients before PRF was 22.7±8.1, and the scores at 6-month and 9 month follow-up were 41.5±6.65 and 41.0±6.67, respectively. A significant OSS improvement (p<0.001) was observed. PRF neuromodulation of the suprascapular nerve is an effective treatment for chronic shoulder pain, and the effect was sustained over a relatively long period in patients with medically intractable shoulder pain.Journal of Korean Neurosurgical Society 12/2013; 54(6):507-10. DOI:10.3340/jkns.2013.54.6.507 · 0.52 Impact Factor
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ABSTRACT: Purpose: The aim of this study was to compare the results of ultrasonographically guided axillary nerve block (ANB) combined with suprascapular nerve block (SSNB) with those of SSNB alone on postoperative pain and satisfaction within the first 48 hours after arthroscopic rotator cuff repair. Methods: Forty-two patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled in this study. Among them, 21 patients were randomly allocated to group 1 and received both SSNB and ANB with 10 mL ropivacaine. The other 21 patients were allocated to group 2 and received SSNB with 10 mL 0.75% ropivacaine and ANB with 10 mL saline. Visual analog scale (VAS) pain score, patient satisfaction (SAT), and lateral pain index (LPI) was checked at 1, 3, 6, 12, 18, 24, 36, and 48 hours postoperatively. Results: Group 1 showed a significantly lower mean VAS score at postoperative 1, 3, 6, 12, 18, and 24 hours compared with group 2 (5.1 < 7.6, 4.4 < 6.3, 3.7 < 5.3, 3.2 < 4.5, 2.7 < 4.0, and 2.7 < 3.4, respectively). A significantly high mean SAT and low mean LPI was observed in group 1 at postoperative 1, 3, 6, 12, 18, 24, and 36 hours (4.9 > 2.4, 5.9 > 3.7, 6.3 > 5.0, 6.8 > 5.7, 7.3 > 6.2, 7.5 > 6.6, and 7.7 > 7.0, respectively), (1.1 < 3.0, 0.8 < 2.5, 0.7 < 2.0, 0.7 < 1.6, 0.6 < 1.3, 0.6 < 1.0, and 0.4 < 0.7, respectively). The frequency of rebound pain decreased in group 1 compared with group 2 (P.032). In addition, rebound phenomenon showed a correlation with ANB on univariate logistic regression (P.034; odds ratio, 0.246). Conclusions: Ultrasonographically guided ANB combined with SSNB in arthroscopic rotator cuff repair showed an improved mean VAS in the first 24 hours after surgery compared with SSNB alone. The mean SAT and LPI of the combined blocks were better than those of the single block within the first 36 hours. Ultrasonographically guided ANB combined with SSNB also decreased the rebound phenomenon.Arthroscopy The Journal of Arthroscopic and Related Surgery 05/2014; 30(8). DOI:10.1016/j.arthro.2014.03.014 · 3.19 Impact Factor