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Transverse ultrasound image of supraclavicular brachial plexus. Arrow points toward the divisions of the brachial plexus. The location of the brachial plexus is posterolateral to the subclavian artery (SA).
Source publication
The article reviews the current literature regarding shoulder anesthesia and analgesia. Techniques and outcomes are presented that summarize our present understanding of regional anesthesia for the shoulder. Shoulder procedures producing mild to moderate pain may be managed with a single-injection interscalene block. However, studies support that m...
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Citations
... Regional anesthesia techniques help control pain both at rest and during early mobilization in the postoperative period. 1,2 Various regional blocks are used for postoperative analgesia in shoulder surgery. The most important of these are the interscalene block (ISB) and suprascapular nerve block (SSNB). ...
... It was shown that the success rate increases by 87-100% with the addition of the supraclavicular block to the ISB. 2 In arthroscopic surgery, the suprascapular nerve block or axillary block, which are applied together, is less effective than the interscalene block. The primary aim of these blocks is to provide capsular innervation of the shoulder, and phrenic nerve paralysis is very rare in these blocks. ...
Background
To compare the analgesic effect of ISB with a combination of ISB-SSNB and patients who were given opioids with PCA without block in adult patients undergoing shoulder surgery, as measured by opioid consumption and pain intensity in the first 24 hours postoperatively.
Methods
Ninety patients who underwent shoulder surgery were randomly divided into three groups. Group I in which ISB was performed and patient-controlled analgesia (PCA) was inserted, Group II with; ISB and SSNB combined, and PCA was inserted, and Group III where; only PCA was used. Visual analog scale (VAS) pain scores at the second, fourth, sixth, 12th, and 24th hours, morphine consumption, additional analgesic requirement, and patient satisfaction were evaluated.
Results
Compared with Group III, the VAS pain score was significantly lower in Group I and Group II at 2, 4, 6, 12, and 24 hours postoperatively. In Group I, the VAS score at rest at the 6th hour was found to be higher than in Group II. The 24-hour total morphine consumption was higher in the control group than in Group I and Group II. The satisfaction score of the control group was lower than Group I and Group II.
Conclusion
The combined application of ISB and SSNB block is beneficial in shoulder surgery to provide both intraoperative and postoperative analgesia and opioid consumption.
Level of Evidence
Level I; Randomized Controlled Trial; Treatment Study.
... Subsequent authors have published variations of this block with the assistance of ultrasound or arthroscopic guidance. 2,14,21 The arthroscopic-assisted axillary block technique combined with a landmarks-based suprascapular nerve block is useful and straightforward for a surgeon to perform intraoperatively in the event that an anesthetist is not trained in the ultrasound-assisted block techniques such as an axillary block or ISB. 16 The addition of the axillary block to the suprascapular nerve block is a relatively new technique, with promising early prospective study results. ...
Background:
The use of regional anesthesia in shoulder arthroscopy improves perioperative pain control, thereby reducing the need for opioids and their recognized side effects. Occasionally one type of block is not suitable for a patient's anatomy or comorbidities or requires a specially trained anesthetist to safely perform. The primary aim of this study is to compare the efficacy of 3 different nerve blocks for pain management in patients undergoing shoulder arthroscopy.
Methods:
A 3-arm, blinded, randomized controlled trial in patients undergoing elective, unilateral shoulder arthroscopic procedures between August 2018 and November 2020 was conducted at a single center. One hundred and thirty participants were randomized into 1 of 3 regional anesthesia techniques. The first group received an ultrasound-guided interscalene block performed by an anesthetist (US + ISB). The second group received an ultrasound-guided suprascapular nerve block and an axillary nerve block by an anesthetist (US + SSANB). The final group received a suprascapular nerve block without ultrasound and an axillary nerve block under arthroscopic guidance by an orthopedic surgeon (A + SSANB). Intraoperative pain response, analgesia requirements, and side effects were recorded. Visual analogue pain scores and opioid doses were recorded in the Post Anaesthesia Care Unit (PACU) and daily for 8 days following the procedure.
Results:
Twelve patients withdrew from the study after randomization, leaving 39 participants in US + ISB, 40 in US + SSANB, and 39 in A + SSANB. The US + ISB group required significantly lower intraoperative opioid doses than US + SSANB and A + SSANB (P < .001) and postoperatively in PACU (P < .001). After discharge from hospital, there were no differences between all groups in daily analgesia requirements (P = .063). There was significantly more nerve complications with 6 patient-reported complications in the US + ISB group (P = .02). There were no reported differences in satisfaction rates between groups (P = .41); however, the A + SSANB group was more likely to report a wish to not have a regional anesthetic again (P = .04).
Conclusion:
The US + ISB group required lower opioid doses perioperatively; however, there was no difference between groups after discharge from PACU. The analgesia requirements between the US + SSANB and A + SSANB were similar intraoperatively and postoperatively. A surgeon-administered SSANB may be a viable alternative when an experienced regional anesthetist is not available.
... Many techniques are used to improve the quality of brachial plexus block like adding an adjuvant, use of ultra sound guided block 6 or insertion of a catheter. 7 In order to avoid catheter complications, adding an adjuvant would be our choice for prolonging the duration of nerve block. ...
Aims: A study was performed to evaluate the effect of dexmedetomidine added to ropivacaine on Supraclavicular brachial Plexus block characteristics, postoperative analgesia, haemodynamics and sedation. Methods: Sixty patients, of ASA grade Ι & ΙΙ of either sex, aged 21 to 60 years, who were undergoing various bony orthopaedic surgeries on the upper limb under supraclavicular brachial plexus block were randomly allocated in to two equal groups of 30 patients each to recieve 29 ml ropivacaine 0.75% plus 1ml saline (group R) and 29 ml ropivacaine 0.75% plus dexmedetomidine 1µg/kg body weight in 1ml saline (group RD) in supraclavicular brachial plexus block. Onset and duration of sensory blocks and motor blocks, duration of analgesia, perioperative haemodynamic parameters, VAS and sedation scores were assessed. Results: Both groups were comparable with regard to demographic data. The onset of sensory and motor block were significantly earlier in group RD as compared to group R. Duration of motor block and analgesia were significantly longer in group RD as compared to group R. Sedation score were significantly higher in group RD. Though HR, NIBP and Respiratory rate were significantly decreased in group RD, however all patients remained haemodynamically stable. Conclusion: Dexmedetomidine (1µg/kg) is a good adjuvant to ropivacaine (0.75%) has faster onset, early and prolonged duration of sensory and motor blockade and increased duration of analgesia, with arousable sedation in supraclavicular brachial plexus block for upper limb surgeries.
... В соответствии с законом Хилтона, нерв, проходящий рядом с суставом, ведет к нему ветви [20]. Гленоид будет получать иннервацию от надлопаточного нерва сзади, подмышечного нерва внизу и от остальной части плечевого сплетения спереди [21]. Таким образом, при парезе Эрба иннервация передней и верхней части гленоида будет сохранена, тогда как иннервация задней и нижней частей гленоида будет нарушена, что усугубляется тем, что оссификация передней и верхней, задней и нижней частей глениоида происходит раздельно F. Soldado и S.H. Kozin предположили, что причиной деформации клювовидного отростка лопатки у детей с ПИТПС является «некое повреждение» общей зоны роста для клювовидного отростка и гленоида, расположенной между верхней частью гленоида и основанием клювовидного отростка [30]. ...
... While some have advocated its use as a sole anesthetic, it is more commonly used in conjunction with general anesthesia (Hadzic et al. 2005). The interscalene block has been the gold standard for shoulder anesthesia, but other nerve blocks such as the suprascapular nerve block with axillary nerve block, supraclavicular block or sub-acromial block have also been used for shoulder surgery with acceptable results (Bowens and Sripada 2012;Singelyn, Lhotel, and Fabre 2004). ...
Purpose
To determine if use of nerve blocks during rotator cuff repairs will result in an overall improvement of post-operative pain and reduction of time spent in the post-anesthesia care unit (PACU) without any increases in avoidable emergency department (ED) or urgent care (UC) visits within 7 and 30 days.
Methods
A large integrated health system was queried for all rotator cuff repairs conducted between January 1, 2016 and December 31, 2017 and separated into two groups: general anesthesia only or general anesthesia with an additional nerve block. Maximal pain scores in the PACU, time spent in the PACU and avoidable visits to the ED/UC within 7 and 30 days were recorded and compared.
Results
A total of 3,128 patients undergoing rotator cuff repair were included (39.5% received general anesthesia with a nerve block). The use of an additional nerve block was associated with a 1.3 (p < 0.001) point reduction in maximum reported pain scores and a 15.7 (11.9%, p < 0.001) minute reduction in PACU time per patient. Furthermore, there was no statistically significant difference in avoidable ED/UC visits within 7 (p = 0.432) and 30 (p = 0.454) days between groups.
Conclusion
The use of a nerve block in addition to general anesthesia was associated with a significant reduction in maximum pain scores and time spent in the PACU with no increases in avoidable ED/UC visits within 7 or 30 days. Therefore, use of a nerve block in addition to general anesthesia could lead to longitudinally decreased costs in the rotator cuff repair surgical pathway.
Level of Evidence
III
... For this reason, the combination of corticosteroid and local anaesthetic were performed in the patients to reduce the possibility of complications caused by corticosteroid in this study. Two randomised studies also showed that SSNB is an effective treatment for patients with chronic shoulder pain compared with placebo and it has been observed to maintain considerable pain relief for about 3 months [18,27]. The results of this study are in accordance with these systematic studies. ...
IntroductionEfforts are recently focused on the management of shoulder impingement syndrome (SIS) with a conservative and targeted approach because of its psychosocial impact, reduction in the quality of life, the cost to the economy and its negative effect on daily activities. Therefore, many studies have been designed to evaluate and compare the effectiveness of different treatments. The main purpose of this study was to identify the effect of combination of subacromial corticosteroid injection (SCI) and suprascapular nerve block (SSNB) on shoulder impingement syndrome (SIS).Materials and methods66 patients with SIS were randomly divided into two groups (33 patients per group): Group 1: SCI; Group 2: SCI plus SSNB. The estimation of the severity of pain by the visual analogue scale (VAS) and shoulder disability using quick DASH (Disabilities of the Arm, Shoulder and Hand) were assessed at baseline and 1, 3 months post-injection.ResultsThe mean age of patients was 55.55 ± 10.42 years in Group 1 and 57.24 ± 12.75 years in Group 2. In steroid group, pre- and post-treatment (at 1 and 3 months) VAS/quickDASH scores were 8.64 ± 0.99/78.03 ± 9.24, 2.09 ± 0.84/15.58 ± 7.23 and 3.06 ± 1.12/25.06 ± 8.74, respectively. In steroid plus SSNB group, pre- and post-treatment (at 1 and 3 months) VAS/quickDASH scores were 8.45 ± 0.90/75.15 ± 9.86, 1.24 ± 0.43/10.88 ± 2.14 and 1.51 ± 0.56/15.51 ± 5.04, respectively. Both treatment groups showed a significant relief of pain at 1 and 3 months post-injection (p < 0.05). However, the VAS and quickDASH scores at 1 and 3 months were significantly lower in Group 2 versus Group 1 (p < 0.05).Conclusion
The combination of SCI and SSNB seems to produce the long-term effect in pain relief and functional improvement.
... The advantages of this technique include easy to learn and master as the landmarks are readily palpable even in a very obese person and the level at which the interscalene technique is performed makes pneumothorax virtually impossible Various local anesthetics have been used to produce brachial plexus block. Bupivacaine 0.5% is one of the most popular drugs used because of its higher potency and prolonged duration of action [2] . One of the drawbacks of Bupivacaine is its cardiotoxicity especially when injected accidentally into the vessels. ...
... For the suprascapular nerve block, the ideal approach ensures blockade of the more proximal branches to the acromion and the subacromial region to maximize coverage. This may be achieved by 4 blocking the nerve in the suprascapular notch. ...
Objective- To compare analgesia, degree of motor block and hemodynamic effects of interscalene block with a combination of interscalene block and suprascapular nerve block employed for anaesthesia for shoulder surgeries. Methods- 46 patients of ASA grade I or II posted for shoulder surgery were divided into two groups of 23 patients each. Group IS received 15 ml local anaesthetic mixture for interscalene brachial plexus block whereas group ISSB received suprascapular nerve block with 5 ml local anaesthetic mixture in addition to interscalene brachial plexus block with 15 ml of similar mixture of local anaesthetic. Heart rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), degree of analgesia and degree of motor blockade were assessed intraoperatively. General anaesthesia was administered in the event of inadequate blockade. Any adverse events were documented. Results- A combination of interscalene block and suprascapular nerve block was superior to interscalene block alone in terms of degree and duration of analgesia as well as degree of motor blockade for shoulder surgeries without any signicant hemodynamic effects in either of the groups. Conclusion- Acombination of interscalene brachial plexus block and suprascapular nerve block is superior to isolated interscalene brachial plexus block for anaesthesia for shoulder surgeries
... However, the procedure for peripheral nerve block entails some difficulties, such as implementation of the nerve stimulation technique, and ultrasonography cannot offer a definitive benefit in preventing major complications such as extremity numbness. 4,9 Successful ambulatory surgery depends on effective analgesics with minimal adverse effects. 25 To block nerves effectively, the local anesthetic should be injected as close to the nerve as possible. ...
Background
Effective pain control in patients who have undergone arthroscopic rotator cuff surgery improves functional recovery and early mobilization. Interscalene blocks (ISBs), a widely used approach, are safe and provide fast pain relief; however, they are associated with complications. Another pain management strategy is the use of a suprascapular nerve block (SSNB).
Hypothesis
We hypothesized that indwelling SSNB catheters are a more effective pain control method than single-shot ISBs. We also hypothesized that indwelling SSNB catheters will reduce the level of rebound pain and the demand for opioid analgesics.
Study Design
Randomized controlled trial; Level of evidence, 1.
Methods
Included in this study were 93 patients who underwent arthroscopic rotator cuff surgery between May 2012 and January 2019. These patients were assigned to either the indwelling SSNB catheter group, the single-shot …
... Acute postoperative pain is the result of complex physiological reactions. The dorsal horn [2] is the site of terminations of primary afferents and there is a complex interaction between such fibres, intrinsic spinal neurons, descending modulatory pain fibres and various neurotransmitters such as Serotonin, ~ 382 ~ Many techniques are used to improve the quality of brachial plexus block like adding an adjuvant, use of ultra sound guided block [8] or insertion of a catheter [9] . In comparison to single-shot block the insertion of peripheral nerve catheter is more time consuming, more painful, costly, and has higher complication rate (eg. ...
