Suprascapular Nerve Block
- Suprascapular nerve block (SSNB)
- Suprascapular nerve blockade
- Typically use the linear transducer, can use curvilinear, with average depth of 3-4 cm
- Transducer should be parallel to the spine of the scapula over suprascapular fossa or notch
- Identify the suprascapular nerve and artery deep to supraspinatus, close to the suprascapular notch
- First described in 1941 by Wertheim and Rovenstein
- Anatomy of the Suprascapular Nerve
- Originates from C5, C6 nerve roots
- Passes through the suprascapular notch which is the target of the block
- Motor: supraspinatus, infraspinatus
- Sensory: coracoclavicular, coracohumeral ligaments, AC joint, glenohumeral joint (posterior, superior aspects), subacromial bursa
- Suprascapular nerve supplies approximately 70% of the sensory input to the shoulder joint
Palpation vs Ultrasound Guidance
- Palpation guided approaches have been described
- This approach is not recommended or discussed here
- Ultrasound guided approach is recommended
- Ultrasound guidance has shown better efficacy at 1 month with fewer complications
- Glenohumeral Arthritis
- Shoulder Dislocation
- Adhesive Capsulitis
- Rotator Cuff Tear, Rotator Cuff Tendonitis
- Following arthroscopic shoulder surgery
- Consider alternative block or analgesia on an as needed basis
- Can use either linear or curvilinear probe depending on preference and patient body habitus
- Local anesthetic
- In most patients, a 2 inch needle should be sufficient
- Place probe posteriorly and identify landmarks prior to starting procedure
- Posterior approach (recommended)
- Patient is seated, ipsilateral arm at side
- Alternatively, ipsilateral hand can rest on contralateral shoulder
- This can be performed in lateral decubitus position or prone
- Superior approach
- Performed with patient seated or supine
- Transducer and Needle Position
- Anatomical coronal oblique plane
- Probe is parallel to the spine of the scapula, over the suprascapular fossa or notch
- Needle approach can be medial to lateral OR lateral to medial
- Identify the suprascapular notch, suprascapular nerve
- Use doppler to identify the suprascapular artery
- Target: suprascapular notch
- Alternative target: floor of the suprascapular fossa
- Guide needle to target
- Typically only need about 5 mL to achieve a complete block
- Patient should be counseled on
- Duration of anesthetic
- Loss of motor function of infraspinatus and supraspinatus
- Reported incidence is less than 1%
- If possible, can reposition arm to opposite shoulder to protract scapula away from chest wall
- This can help reduce the likelihood of fenestrating the pleural cavity
- Intravascular injection
- Residual motor block
- Local trauma
- ↑ 1.0 1.1 Chan, Chin-wern, and Philip WH Peng. "Suprascapular nerve block: a narrative review." Regional Anesthesia & Pain Medicine 36.4 (2011): 358-373.
- ↑ Wertheim HM, Rovenstein EA. Suprascapular nerve block. Anesthesiology. 1941;2:541Y545.
- ↑ Ajmani ML. The cutaneous branch of the human suprascapular nerve. J Anat. 1994;185:439Y442.
- ↑ Chan, Chin-wern, and Philip WH Peng. "Suprascapular nerve block: a narrative review." Regional Anesthesia & Pain Medicine 36.4 (2011): 358-373.
- ↑ Gorthi, Venkat, Young Lae Moon, and Jeong-Hoon Kang. "The effectiveness of ultrasonography-guided suprascapular nerve block for perishoulder pain." Orthopedics 33.4 (2010): 238-241.
- ↑ Tezel, Onur, et al. "A comparison of suprascapular nerve block and procedural sedation analgesia in shoulder dislocation reduction." The American journal of emergency medicine 32.6 (2014): 549-552.
- ↑ Kaya, Murtaza, et al. "Interscalene or suprascapular block in a patient with shoulder dislocation." The American journal of emergency medicine 35.1 (2017): 195-e1.
- ↑ Hassen, Getaw Worku, et al. "The Use of a Suprascapular Nerve Block to Facilitate the Reduction of an Anterior Shoulder Dislocation: An Alternative for Elderly Patients?." Journal of Emergency Medicine.
- ↑ Ozkan, Korhan, et al. “Suprascapular nerve block for the treatment of frozen shoulder.” Saudi journal of anaesthesia 6.1 (2012): 52.
- ↑ Jung, Tae Wan, et al. “Does combining a suprascapular nerve block with an intra-articular corticosteroid injection have an additive effect in the treatment of adhesive capsulitis? A comparison of functional outcomes after short-term and minimum 1-year follow-up.” Orthopaedic journal of sports medicine 7.7 (2019): 2325967119859277.
- ↑ Herring, Andrew A., Micheal B. Stone, and Arun Nagdev. "Ultrasound-guided suprascapular nerve block for shoulder reduction and adhesive capsulitis in the ED." The American journal of emergency medicine 29.8 (2011): 963-e1.
- ↑ Meyer-Witting M, Foster JMG. Suprascapular nerve block in the management of cancer pain. Anaesthesia. 1992;47:626.
- ↑ Breen TW, Haigh JD. Continuous suprascapular nerve block for analgesia of scapular fracture. Can J Anaesth. 1990;37:786Y788.
- ↑ Moore DC. Block of the suprascapular nerve. In: Moore DC, ed. Regional Block. 4th ed. Springfield, IL: Charles C. Thomas Co; 1979.
John Kiel on 12 August 2022 15:55:23
14 April 2023 14:24:40