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Infraspinatus-teres minor (ITM) interfascial block: a novel approach for combined suprascapular and axillary nerve block
  1. Shin Hyung Kim1,2,
  2. In-Seung Yeo2,3,
  3. Jaewon Jang1,
  4. Hyun Eom Jung1,
  5. Yong-Min Chun4,5 and
  6. Hun-Mu Yang2,3,5
  1. 1Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seodaemun-gu, Republic of Korea
  2. 2Translational Research Unit for Anatomy and Analgesia, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
  3. 3Department of Anatomy, Yonsei University College of Medicine, Seodaemun-gu, Republic of Korea
  4. 4Department of Orthopedic Surgery, Yonsei University College of Medicine, Seodaemun-gu, Republic of Korea
  5. 5Surgical Anatomy Education Center, Yonsei University College of Medicine, Seodaemun-gu, Republic of Korea
  1. Correspondence to Dr Hun-Mu Yang, Department of Anatomy, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of); yanghm{at}yuhs.ac

Abstract

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.

  • analgesia
  • Nerve Block
  • Ultrasonography

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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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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Footnotes

  • SHK and I-SY contributed equally.

  • Correction notice This article has been corrected sine it published Online First. Errors in the second paragraph of the discussion section have been amended.

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.