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

Hand Surgery and Microsurgery Unit, University-Hospital Careggi, Florence, Italy.
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.21). 07/2008; 24(6):689-96. DOI: 10.1016/j.arthro.2008.01.019
Source: PubMed


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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    • "SSNB has been investigated in various types of chronic shoulder pain disorders3). Moreover, SSNB has a long history of reducing pain and improving ROM in patients with shoulder pain including rotator cuff lesions and frozen shoulder2,4,17,21,23). Several studies have reported that SSNB provides significant and sustained pain relief and improvement in disability scores and ROM in degenerative disease and conditions that are inflammatory in origin21). "
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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.
    Full-text · Article · Dec 2013 · Journal of Korean Neurosurgical Society
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    • "As previously mentioned, the majority of the nerve supply to the shoulder is provided by the suprascapular and axillary nerves (Figures 1 and 2). When these nerves are blocked separately, there may be fewer complications and side effects than the traditional interscalene block [3, 4]. The phrenic nerve is not blocked; therefore, these blocks may be used for patients that are not candidates for an interscalene block, for example, severe chronic obstructive pulmonary disease or contra-lateral hemidiaphragmatic paresis. "
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    ABSTRACT: 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 moderate to severe pain, lasting for several days is best managed with a continuous interscalene block. This may cause increased extremity numbness, but will provide greater analgesia, reduce supplemental opioid consumption, improve sleep quality and patient satisfaction. In comparison to the nerve stimulation technique, ultrasound can reduce the volume of local anesthetic needed to produce an effective interscalene block. However, it has not been shown that ultrasound offers a definitive benefit in preventing major complications. The evidence indicates that the suprascapular and/or axillary nerve blocks are not as effective as an interscalene block. However in patients who are not candidates for the interscalene block, these blocks may provide a useful alternative for short-term pain relief. There is substantial evidence showing that subacromial and intra-articular injections provide little clinical benefit for postoperative analgesia. Given that these injections may be associated with irreversible chondrotoxicity, the injections are not presently recommended.
    Full-text · Article · Jun 2012 · Anesthesiology Research and Practice
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    ABSTRACT: Justificativa y objetivos: El dolor en el hombro es un quejido frecuente que ocasiona una gran incapacidad funcional en el miembro perjudicado, como también la reducción en la calidad de vida de los pacientes. El bloqueo del nervio supraescapular es un método terapéutico eficaz y ha ve-nido siendo cada vez más utilizado por los anestesiólogos tanto para la anestesia regional como para la analgesia postoperatoria de cirugías rea-lizadas en esa articulación, lo que justifica la presente revisión cuyo objetivo principal es describir la técnica aplicada y las indicaciones clínicas. Contenido: Presentamos la anatomía del nervio supraescapular, desde su origen, y desde el plexo braquial hasta sus ramas terminales, como también las características generales y la técnica usada en la ejecución del bloqueo de ese nervio, los principales fármacos utilizados y el volu-men y las situaciones en que se justifica su aplicación.
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