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Ultrasound-Guided Suprascapular Nerve Block, Description of a Novel Supraclavicular Approach
  1. Andreas Siegenthaler, MD*,
  2. Bernhard Moriggl, MD,
  3. Sabine Mlekusch, MD,
  4. Juerg Schliessbach, MD,
  5. Matthias Haug, MD,
  6. Michele Curatolo, MD, PhD and
  7. Urs Eichenberger, MD
  1. From the *Pain Center, Department of Anesthesiology, University Hospital of Lausanne (CHUV), Lausanne;
  2. Department of Anatomy, Histology and Embryology, Innsbruck Medical University, Innsbruck, Austria; and
  3. University Department of Anesthesiology and Pain Therapy, University of Bern, Inselspital, Bern, Switzerland.
  1. Address correspondence to: Andreas Siegenthaler, MD, Pain Center, Department of Anesthesiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland (e-mail: andisiegenthaler{at}gmail.com).

Abstract

Background and Objectives The suprascapular nerve (SSN) block is frequently performed for different shoulder pain conditions and for perioperative and postoperative pain control after shoulder surgery. Blind and image-guided techniques have been described, all of which target the nerve within the supraspinous fossa or at the suprascapular notch. This classic target point is not always ideal when ultrasound (US) is used because it is located deep under the muscles, and hence the nerve is not always visible. Blocking the nerve in the supraclavicular region, where it passes underneath the omohyoid muscle, could be an attractive alternative.

Methods In the first step, 60 volunteers were scanned with US, both in the supraclavicular and the classic target area. The visibility of the SSN in both regions was compared. In the second step, 20 needles were placed into or immediately next to the SSN in the supraclavicular region of 10 cadavers. The accuracy of needle placement was determined by injection of dye and following dissection.

Results In the supraclavicular region of volunteers, the nerve was identified in 81% of examinations (95% confidence interval [CI], 74%–88%) and located at a median depth of 8 mm (interquartile range, 6–9 mm). Near the suprascapular notch (supraspinous fossa), the nerve was unambiguously identified in 36% of examinations (95% CI, 28%–44%) (P < 0.001) and located at a median depth of 35 mm (interquartile range, 31–38 mm; P < 0.001). In the cadaver investigation, the rate of correct needle placement of the supraclavicular approach was 95% (95% CI, 86%–100%).

Conclusions Visualization of the SSN with US is better in the supraclavicular region as compared with the supraspinous fossa. The anatomic dissections confirmed that our novel supraclavicular SSN block technique is accurate.

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Footnotes

  • The authors declare no conflict of interest.

  • Funding was received from Scientific Funds of the University Department of Anesthesiology and Pain Therapy, Inselspital, Bern, Switzerland.

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