Background Combined suprascapular and axillary nerve block could be an analgesic option for shoulder pain control. The current description of this technique requires performing the block procedures at two different sites without consideration for catheter placement. We hypothesized that a single site injection to the interfascial plane between the infraspinatus and teres minor would result in an injectate spread to the suprascapular and axillary nerves.
Methods We performed 10 injections with this approach using 25 mL dye solution in 10 shoulders of five unembalmed cadavers. Also, we described three case reports, two single-injection cases and one catheter-placement case, using this approach in patients with acute postsurgical pain and chronic pain in their shoulder region.
Results In cadaveric evaluations, dye spreading to the suprascapular nerves on the infraspinatus fossa and the spinoglenoid notch cephalad and axillary nerves in the quadrilateral space caudally were observed in all injections. In addition, the most posterolateral part of the joint capsule was stained in 8 out of 10 injections. There was no dye spreading on the nerves to the subscapularis or lateral pectoral nerves. Clinically successful analgesia with no adverse events was achieved in all three cases.
Conclusion Our anatomical and clinical observations demonstrated that an injection to the interfascial plane between the infraspinatus and teres minor consistently achieved injectate spreading to both suprascapular and axillary nerves, which innervate the glenohumeral joint.
- Nerve Block
Data availability statement
Data are available upon reasonable request. Deidentified data will be made available upon reasonable written request submitted to the corresponding author.
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SHK and I-SY contributed equally.
Contributors SHK and I-SY (these authors contributed equally to this work) were involved with study conception, design, clinical and anatomical data acquisition, data analysis, interpretation, and figure preparation, drafting of the paper. JJ, HEJ, and Y-MC were involved with clinical data acquisition, clinical data analysis/interpretation and drafting of the paper. H-MY was involved with study conception, design, anatomical data acquisition, anatomical data analysis, interpretation, figure preparation and drafting of the paper. All authors read and gave final approval of the version to be published.
Funding This work was supported by the 'Hankookilbo Myung-Ho Seung' Faculty Research Assistance Program of Yonsei University College of Medicine (grant number 6-2022-0069).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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