Suprascapular Nerve Block Group Research Articles

Suprascapular nerve block versus intraarticular corticosteroid in the treatment of periarthritis shoulder

Periarthritis shoulder, Frozen shoulder or adhesive capsulitis, presents as a significant clinical challenge with various therapeutic strategies being explored. This study aimed to compare the efficacy of suprascapular nerve block (SSNB) and intraarticular steroids, both adjunctive to physical therapy, in managing periarthritis shoulder. : We conducted a comparative study involving 50 patients diagnosed with frozen shoulder. Patients were segregated into two groups: one received SSNB (n=25), and the other received intraarticular steroids, followed by physical therapy in both groups.: Patients undergoing SSNB showed a significant reduction in SPADI scores over a 12-week follow-up period, with a mean reduction of 64%. This group also recorded patient satisfaction scores of 8.5 ± 1.2 on a VAS (0-10) and a quality of life score of 85 ± 10 on the SF-36 scale. In contrast, the intraarticular steroids group, while also showing improvement, lagged behind the SSNB group in these metrics.: SSNB, when combined with physical therapy, emerges as a promising therapeutic strategy for periarthritis shoulder, demonstrating superior efficacy compared to intraarticular steroids in terms of pain reduction, function enhancement, and patient satisfaction. Further extensive studies are warranted to affirm these findings.

Comparison of the analgesic efficacy between arthroscopically placed continuous suprascapular nerve block and ultrasound-guided continuous superior trunk block: a double-blinded randomized controlled trial.

Single-shot suprascapular nerve block and superior trunk block have been reported to provide a non-inferior analgesic effect after shoulder surgery with a lesser incidence of hemidiaphragmatic paresis compared with interscalene brachial plexus block. This study hypothesized that continuous suprascapular nerve block provides non-inferior analgesia with minimal effects on diaphragmatic movement compared with continuous superior trunk block in patients undergoing arthroscopic shoulder surgery. We randomized 100 patients undergoing arthroscopic shoulder surgery between December 2020 and October 2021 into continuous suprascapular nerve block and continuous superior trunk block groups. Before the surgery, patients received either a single-shot superior trunk block or subomohyoid suprascapular nerve block. Thereafter, a superior trunk catheter was inserted by anesthesiologists in patients in the continuous superior trunk block group, and a posterior suprascapular nerve catheter was inserted with arthroscopic assistance during the surgery by surgeon in the continuous suprascapular nerve block group. The primary outcome was the postoperative pain score at postoperative 24 h, and the incidence of hemidiaphragmatic paresis was also compared. Overall, 98 patients were included in the final analysis. The worst and resting pain scores at postoperative 24 h in the continuous suprascapular nerve block group were inferior compared with those in the continuous superior trunk block group in the test with a non-inferiority margin of 1 (worst pain score, mean difference: 0.9, 95% CI 0.1 to 1.7; resting pain score: mean difference: 0.5, 95% CI 0.0 to 1.0). However, the continuous suprascapular nerve block group had a significantly lower incidence of hemidiaphragmatic paresis at postoperative 24 h than the continuous superior trunk block group. Continuous suprascapular nerve block provides statistically inferior analgesia compared to the continuous superior trunk block; however, the continuous suprascapular nerve block had a minimal effect on the phrenic nerve function.

Suprascapular nerve block is faster and as effective as hydrodistension in relieving frozen shoulder-associated pain and disability: A prospective, single-blind observational study with a follow-up of 24 weeks.

Hydrodistension (HD) and suprascapular nerve block (SSNB) have been shown to reduce pain and improve shoulder function in frozen shoulder (FS). The aim of this study was to compare the efficacy of HD and SSNB in the treatment of idiopathic FS. This was a prospective observational study. A total of 65 patients with FS were treated with SSNB or HD. The functional outcome was evaluated by Shoulder Pain and Disability Index (SPADI) score and active shoulder range of motion (ROM) measured at 2 weeks, 6 weeks, 12 weeks, and 24 weeks. Parametric data were analyzed using an independent sample T-test. Nonparametric data were analyzed using the Mann-Whitney test and Wilcoxon test. A P value less than 0.05 was considered significant. At the end of 24 weeks, the two-group improved significantly from the baseline and the improvement was comparable between the two groups. ROM also improved significantly in both groups. At 2nd week, SPADI score was significantly less in SSNB group (P < 0.05). About 43% of patients considered HD extremely painful. Both HD and SSNB are almost equally effective in reducing pain and improving shoulder function. However, SSNB leads to a faster improvement.

Randomized control study comparing the functional outcome of suprascapular nerve block and hydrodistension in the treatment of frozen shoulder

Background: Frozen shoulder or adhesive capsulitis (AC) is a common musculoskeletal disease which imposes significant morbidity and affects the quality of life. The present study was done to compare the effectiveness of the suprascapular nerve block (SSNB) under ultrasound guidance and hydrodistension in the management of AC. Materials and Methods: This prospective randomized control study was conducted in 60 patients visiting the Department of Orthopaedic Surgery, BARC Hospital, Mumbai, with AC not improving with physiotherapy. Patients were divided into Group A (n = 30) who received SSNB under ultrasound guidance in addition to physiotherapy and Group B (n = 30) who underwent hydrodistension of shoulder in addition to physiotherapy. Values for the ROM, Quick DASH score, and visual analog scale (VAS) score were obtained for each patient at the baseline and at 4, 8, and 12 weeks. Results: Female preponderance was observed in both the groups and overall 22% werediabetics. The difference in improvement in flexion, abduction, external rotation, and internal rotation from baseline to 12 weeks, 4 to 8 weeks, 4 to 12 weeks, and 8 to 12 weeks was higher in hydrodistension group as compared to SSNB group (p &lt; 0.05). The decrease in the VAS and Quick DASH scores from baseline to 12 weeks was higher in hydrodistension group as compared to SSNB group (p &lt; 0.05). Conclusion: Both SSNB and hydrodistension are useful in the management of AC. However, hydrodistension displayed better outcome as compared to SSNB in improving the functional outcome of patients.

Is Suprascapular Nerve Block Better Than Intra-articular Corticosteroid Injection for the Treatment of Adhesive Capsulitis of the Shoulder? A Randomized Controlled Study.

Adhesive Capsulitis of shoulder (AdCS) is a treatment dilemma for surgeons. Intraarticular Corticosteroid Injection (IACI) has shown only short-term benefit in improving shoulder-related disability. Suprascapular nerve block (SSNB) has shown promise in trials in reducing chronic shoulder pain. Thus a RCT was conducted to compare the efficacy of SSNB versus IACI in the treatment of AdCS. 86 patients with AdCS were divided into SSNB and IACI groups by block randomization. SSNB group received single Suprascapular Nerve Block with 10ml of 0.5% Bupivacaine while IACI group received single injection of 40mg Triamcinolone and 1ml 2% Lignocaine in the shoulder; both followed by physiotherapy and followed-up and evaluated with SPADI and modified Constant scores at 1, 6 and 12 weeks. Statistically significant improvements occurred in both groups. At 12 weeks, the SPADI and Con-stant score for SSNB improved to 9.62±10.07 and 36.95±3.43 respectively (p&lt;0.001); and for IACI improved to 11.65±5.56 and 35.07±3.32 respectively (p &lt;0.001). The difference in the scores between the 2 groups at 1st and 6th week was insignificant, but was statistically significant in favour of SSNB at 12 weeks (p=0.002). 1. Thus, from the present study it can be concluded that both Suprascapular Nerve Block and Intra-articular Corticosteroid injection are effective mo-dalities of treatment for Adhesive Capsulitis of the shoulder. 2. Suprascapular Nerve Block increased patients' pain tolerability for effective mobilization, the effect be-ing persistent even at 12 weeks following injection. 3. It was safer than Intra-articular Corticosteroid in-jection with less incidence of adverse effects in our study and the literature. 4. It is an easy-to-perform outpatient procedure, with minimal chance of infection and other complications. 5. In light of the above, we may recommend Su-prascapular Nerve Block as the initial procedure of choice in patients with Adhesive Capsulitis of Shoulder.

Suprascapular nerve block is a clinically attractive alternative to interscalene nerve block during arthroscopic shoulder surgery: a meta-analysis of randomized controlled trials

BackgroundThe interscalene brachial plexus block (ISB) is a commonly used nerve block technique for postoperative analgesia in patients undergoing shoulder arthroscopy surgery; however, it is associated with potentially serious complications. The use of suprascapular nerve block (SSNB) has been described as an alternative strategy with fewer reported side effects for shoulder arthroscopy. This review aimed to compare the impact of SSNB and ISB during shoulder arthroscopy surgery.MethodsA meta-analysis was conducted to identify relevant randomized controlled trials involving SSNB and ISB during shoulder arthroscopy surgery. Web of Science, PubMed, Embase, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CNKI, and Wanfang database were searched from 2010 through March 2021.ResultsWe identified 1255 patients assessed in 17 randomized controlled trials. Compared with the ISB group, the SSNB group had higher VAS at rest in PACU (P = 0.003), 1 h after operation (P = 0.005), similar pain score 2 h (P = 0.39), 3-4 h (P = 0.32), 6-8 h after operation (P = 0.05), then lower VAS 12 h after operation (P = 0.00006), and again similar VAS 1 day (P = 0.62) and 2 days after operation (P = 0.70). As for the VAS with movement, the SSNB group had higher pain score in PACU (P = 0.03), similar VAS 4-6 h after operation (P = 0.25), then lower pain score 8-12 h after operation (P = 0.01) and again similar VAS 1 day after operation (P = 0.3) compared with the ISB group. No significant difference was found for oral morphine equivalents use at 24 h (P = 0.35), duration of PACU stay (P = 0.65), the rate of patient satisfaction (P = 0.14) as well as the rate of vomiting (P = 0.56), and local tenderness (P = 0.87). However, the SSNB group had lower rate of block-related complications such as Horner syndrome (P < 0.0001), numb (P = 0.002), dyspnea (P = 0.04), and hoarseness (P = 0.04).ConclusionOur high-level evidence established SSNB as an effective and safe analgesic technique and a clinically attractive alternative to interscalene block with the SSNB’S advantage of similar pain control, morphine use, and less nerve block-related complications during arthroscopic shoulder surgery, especially for severe chronic obstructive pulmonary disease, obstructive sleep apnea, and morbid obesity. Given our meta-analysis’s relevant possible biases, we required more adequately powered and better-designed RCT studies with long-term follow-up to reach a firmer conclusion.

Suprascapular Nerve Block Is an Effective Pain Control Method in Patients Undergoing Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.

Background:Effective pain control in patients who have undergone arthroscopic rotator cuff surgery improves functional recovery and early mobilization. Interscalene blocks (ISBs), a widely used approach, are safe and provide fast pain relief; however, they are associated with complications. Another pain management strategy is the use of a suprascapular nerve block (SSNB).Hypothesis:We hypothesized that indwelling SSNB catheters are a more effective pain control method than single-shot ISBs. We also hypothesized that indwelling SSNB catheters will reduce the level of rebound pain and the demand for opioid analgesics.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:Included in this study were 93 patients who underwent arthroscopic rotator cuff surgery between May 2012 and January 2019. These patients were assigned to either the indwelling SSNB catheter group, the single-shot ISB group, or the control (sham/placebo) group (31 patients per group). Level of pain was measured with a visual analog scale (VAS; 0 to 10 [worst pain]) on the day of the operation. The preoperative VAS score was recorded at 6 AM on the day of operation, and the postoperative scores were recorded at 1, 8, and 16 hours after surgery and then every 8 hours until postoperative day 3.Results:The VAS pain scores were lower in the SSNB and ISB groups than in the control group up to postoperative hour (POH) 8, with the most significant difference at POH 8. At POH 1 and POH 8, the mean VAS scores for each group were 2.29 and 1.74 (SSNB), 2.59 and 2.50 (ISB), and 3.42 and 4.48 (control), respectively. VAS scores in the SSNB and ISB groups were consistently <3, compared with a mean VAS score of 3.1 ± 1.58 in the control group (P < .001). Compared with the ISB group, the SSNB group had significantly fewer side effects such as rebound pain duration as well as lower VAS scores (P < .001).Conclusion:VAS scores were the lowest in the indwelling SSNB catheter group, with the most pronounced between-group difference in VAS scores at POH 8. Severity and recurring frequency of pain were lower in the indwelling SSNB catheter group than in the single-shot ISB group.

Differential lung ventilation assessed by electrical impedance tomography in ultrasound-guided anterior suprascapular nerve block vs. interscalene brachial plexus block: A patient and assessor-blind, randomised controlled trial.

Ultrasound-guided interscalene brachial plexus block (ISB) is used to control pain after shoulder surgery. Though effective, drawbacks include phrenic nerve block and motor block of the hand. The ultrasound-guided anterior approach to perform suprascapular nerve block (SSNB) may provide a good alternative. To compare lung ventilation and diaphragmatic activity on the operated side in ISB and SSNB. Randomised, controlled patient-blinded and assessor-blinded trial. Outpatient surgical clinic with recruitment from June 2017 to January 2018. Fifty-five outpatients scheduled for arthroscopic shoulder surgery were allocated randomly to receive SSNB or ISB. Technical problems with monitoring devices unrelated to the intervention led to exclusion of seven patients. The remaining 48 (n=24 in each group) were followed up for 24 h without drop-outs. Patients received 10 ml of ropivacaine 1.0% wt/vol for both procedures. Percentage lung ventilation on the operated side was the primary endpoint as assessed with electrical impedance tomography (EIT). Secondary endpoints were hemidiaphragmatic motion on the operated side, pain, opioid use, hand strength and numbness, and patient satisfaction. Before regional anaesthesia, the lung on the operated side contributed a median [IQR] of 50 [42 to 56]% of the total lung ventilation. Postoperatively, it was 40 [3 to 50]% (SSNB) vs. 3 [1 to 13]% (ISB) for an adjusted difference of 23 (95% CI, 13 to 34)%, (P < 0.001). Hemidiaphragmatic motion was 1.90 (95% CI, 1.37 to 2.44 cm), (P < 0.001) lower in the ISB group compared with the SSNB group. Hand strength was 11.2 (95% CI 3.6 to 18.9), (P = 0.0024) kg greater for SSNB and numbness was observed in 0% (SSNB) vs. 46% (ISB) of patients, P < 0.001. Pain was low in the first 6 h after surgery in both groups with slightly, but not significantly, lower values for ISB. No meaningful or significant differences were found for opioid use or patient satisfaction. An ultrasound-guided anterior approach to SSNB preserves ipsilateral lung ventilation and phrenic function better than a standard ISB. drks.de identifier: DRKS00011787.

Comparative study of the effect of suprascapular nerve block under ultrasound guidance and blind shoulder infiltration (Using lignocaine and methylprednisolone acetate) in chronic shoulder pain

Introduction: Shoulder joint is very important joint for day to day activities and pain in shoulder results in leads to increased functional disability with poor quality-of life. Chronic shoulder pain common complaints encountered by treating physicians all over world. The incidence of chronic shoulder pain is approximately 15-30% with variations among different population and age groups. The treatment modalities available for alleviating chronic shoulder pain varies from simple anti-inflammatory drugs to interventional procedures like intra-articular steroid injections, supra-scapular nerve block (SSNB).AIM: To compare the pain relief and return of function in shoulder joint using suprascapular nerve block under ultrasound guidance (lignocaine and methylprednisolone acetate) versus shoulder infiltration (lignocaine and methylprednisolone acetate) in chronic shoulder pain.Study Design: Prospective, randomised study, data was collected from patients with chronic shoulder pain in the age group of 18-60 years coming to orthopedic outpatient department at Yenepoya Medical College Hospita with chronic shoulder pain.Materials and Methods: Suprascapular nerve block group: 2ml of 40mg methyl prednisolone +2ml of lignocaine given, supervision of anesthetist under ultrasound guidance. Intra articular steroid group: 2ml of 40mg methyl prednisolone acetate +2ml 2% lignocaine hydrochloride given through posterior approach to shoulder. Eligible participants was randomly assigned to receive the same combination of medications either by supra scapular nerve block under ultrasound guidance or blind shoulder infiltration and compare the effect of lignocaine and corticosteroid in suprascapular nerve block and shoulder infiltration in chronic shoulder pain by assessing DASH score, Constant-Murley score, SPADI score and VAS pain score on day 7 and day 28 of the procedure.Results: There were no significant differences between the groups in terms of pain, demographic variables, Range of movement and disability scores when compared to baseline. (p >0.05). However suprascapular nerve block showed slight better improvement in pain, range of movement and disability score at initial (i.e. at 1week) and at 4 week follow up when compared with that of intra-articular steroid infiltration but scores were not statistically significant. Parameters obtained in both groups were significant at final assessments when compared to the baseline scores.Conclusion: Suprascapular nerve block can be considered as a safe, effective, well tolerated treatment and alternative line of treatment in patient suffering from chronic shoulder pain.

Efficacy of ultrasound-guided suprascapular nerve block treatment in patients with painful hemiplegic shoulder.

The aim of this study was to evaluate the efficacy of ultrasound-guided suprascapular block treatment in patients with painful hemiplegic shoulder whose pain was not reduced after conservative treatment. The patients were those whose hemiplegic shoulder pain was not reduced by standard conservative treatment prior to discharge. The study group (n = 21) included patients who had undergone an ultrasound-guided suprascapular nerve block (SSNB). The control group (n = 21) were patients who had not undergone SSNB. Both groups undertook home exercise programs. All patients were evaluated at 1week and 1 and 3months after the discharge. Evaluations included shoulder range of motion (ROM), Visual Analog Scale (VAS) for pain, EQ-5D-3L for quality of life, the Modified Ashworth Scale (MAS), and Brunnstrom staging. The shoulder ROM significantly increased in the SSNB group at 1-3months, when compared with the baseline value. The shoulder ROM significantly decreased (p˂0.05) in the control group at 1-3months, when compared with the baseline value. The pain VAS and EQ-5D-3L scores significantly decreased (p˂0.05) after treatment in the follow-ups at 1month in the SSNB group. The control group showed no change from the baseline scores (p˃0.05). The MAS scores and Brunnstrom staging did not differ between the two groups. The ultrasound-guided SSNB is a safe and more effective treatment than conservative treatment for painful hemiplegic shoulder. Further studies are needed to compare ultrasound-guided and non-guided suprascapular blocks as treatments for hemiplegic shoulder pain.

Efficacy of suprascapular nerve block compared with subacromial injection: a randomized controlled trial in patients with rotator cuff tears

We aimed to compare the clinical efficacy of a suprascapular nerve block (SSNB) versus subacromial injection (SA) for outpatient treatment of patients with symptomatic rotator cuff tears in a double-blinded, randomized controlled trial using sealed-envelope randomization. A total of 42 participants with symptomatic partial- and full-thickness rotator cuff tears quantified by ultrasound or magnetic resonance imaging received either an ultrasound-guided SSNB or SA. The primary outcome measure was shoulder function measured by the modified Constant-Murley (CM) score and the secondary outcome was the pain score measured by a visual analog scale at 2, 6, and 12 weeks after injection. We analyzed 43 shoulders (27 in male patients, 62.2%). The mean age was 65.2 years (standard deviation [SD], 11.9 years). Of the shoulders, 22 (51.2%) underwent SAs and 21 (48.8%) underwent SSNBs. Continuous variables were analyzed by an independent t test (2 tailed), and nominal data were analyzed by the Fisher exact test (1 sided). At 6 weeks, the mean change from the baseline CM score was significantly higher in the SSNB group than in the SA group (14.3 [SD, 18.1] vs 3.0 [SD, 12.8]; P = .048). At 12 weeks' follow-up, the SSNB group had a significantly higher CM score than the SA group (57.6 [SD, 10] vs 44.6 [SD, 16]; P = .023) and greater improvement from the baseline CM score (23.4 [SD, 17.5] vs 7.8 [SD, 16.5]; P = .014). At 12 weeks, the visual analog scale score was significantly better in the SSNB group than in the SA cohort (9.9 [SD, 3.3] vs 7.3 [SD, 4.3]; P = .03). This study demonstrates that an SSNB resulted in better pain and functional results than an SA at 6 and 12 weeks for symptomatic rotator cuff tears.

Frozen shoulder: evaluation of intraarticular corticosteroids injection versus suprascapular nerve block “A prospective clinical study”

Introduction: Adhesive capsulitis (frozen shoulder) has an incidence of 3-5% in the general population. This disorder is one of the most common musculoskeletal problem seen in orthopaedics. Aims and objectives 1. The study was designed to assess the effectiveness of suprascapular nerve block (SSNB) and intra articular steroid (IAS) to relieve pain and improve range of motion. 2. To assess which one had better results in terms of simple pain score and SPADI (shoulder pain and disability index) score along with range of movement at shoulder joint. 3. To record any adverse effects and complications. Materials and methods: The study was conducted in department of orthopaedics, S.M.S. Medical college and attached group of hospitals, Jaipur, with due permission from institutional ethical committee and review board after taking informed and written consent from the patient from 1.4.2015 to 1.4.2016 Study design: hospital based, prospective, randomized, comparative study. Sample size: Sample size was calculated to be 23 subjects in each of 2 groups. Inclusion criteria 1. Patients with history of chronic shoulder pain and decreased range of motion (active and passive) of shoulder. 2. Age group 40-70 years. 3. Either sex. 4. Patients with pain and stiffness for atleast 4 weeks. 5. Who have been on conservative management like pain killers, physiotherapy etc. 6. Patients who give consent to participate in study. 7. Diabetic patients whose HbA1c is less than 6.5% and fasting blood sugar levels are less than 126 mg/dl. Exclusion criteria 1. Patients with intrinsic pathologies of the shoulder such as a) rotator cuff tears b) biceps tendinitis c) Calcific tendinosis. d) History of fracture and dislocation. e) Arthritis of glenohumeral or acromioclavicular joint. f) Sympathetic dystrophy. 2. Patients with extrinsic problems such as a) Neuromuscular disorders (Parkinsonism). b) Referred pain from associated conditions- extrusion of a cervical disc with radiculopathy. c) History of previous surgery of affected shoulder. 3. Patients who refuse to participate in study Results: In early follow ups there was significant improvement in abduction in IAS group than SSNB group, but at final follow up almost normal range of motion was achieved in both the groups. The average improvement in abduction in SSNB group was 86.92º and 68.46º in IAS group. Both groups achieved almost normal range of ER movement at final follow up. The average improvement in ER was 25.19º (SSNB- 32.3º & IAS – 18.08º).All groups achieved significant improvement in pain and restriction of movement and achieved almost normal day to day activity at final follow up. Overall good to excellent results were seen in both the groups.

Suprascapular Nerve Block Versus Interscalene Block as Analgesia After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Noninferiority Trial

To compare the efficacy of suprascapular nerve block (SSB) and interscalene block (ISB) as postoperative analgesia within the first 24hours after arthroscopic supraspinatus and/or infraspinatus tendon repair. A single-blind, randomized controlled study was performed between 2013 and 2014. The inclusion criteria were arthroscopic supraspinatus and/or infraspinatus tendon repair confirmed intraoperatively, with or without associated procedures, and informed consent. The exclusion criteria were a previously operated shoulder, repair of the subscapularis tendon, and an allergy to local anesthetics. ISB was performed under ultrasound guidance by an anesthesiologist, whereas SSB was performed based on specific anatomic landmarks by a surgeon. The primary evaluation criterion was mean shoulder pain score during the first postoperative 24hours assessed on a visual analog scale by the patient. The secondary criteria were complications of locoregional anesthesia, the use of analgesics in the recovery room (the first 2hours) until postoperative day 7, and pain (visual analog scale) during the first week. Forty-four patients were needed for this noninferiority study. An institutional review board approved the study. Seventy-four patients were randomized, and 59 met the intraoperative inclusion criteria. Six patients were excluded (1 for pneumothorax after ISB, 1 for unsuccessful SSB, and 4 for incomplete questionnaires). None of the patients were lost to follow-up. There was no significantdifference between the SSB and ISB groups in mean pain score for the first 24hours (P= .92) or the first 7days (P= .05). However, there was significantly less pain in the ISB group in the recovery room (P= .01). Consumption of analgesics wascomparable between the groups, but the SSB group took significantly more morphine in the recovery room. In this prospective, randomized controlled study, SSB was as effective as ISB for mean pain control within the first 24hours but ISB was more effective in relieving pain in the recovery room after arthroscopic supraspinatus and/or infraspinatus tendon repair. Level I, therapeutic, randomized controlled study.

Clinical evaluation of post-operative analgesia comparing suprascapular nerve block and interscalene brachial plexus block in patients undergoing shoulder arthroscopic surgery.

Shoulder arthroscopic surgeries have a high incidence of severe post-operative pain significant enough to interfere with recovery and rehabilitation. A regional anaesthetic technique combined with general anaesthesia reduces intra-operative requirements of anaesthesia and provides a better post-operative pain relief. As the commonly employed technique of interscalene brachial plexus block (ISB) is associated with potential serious complications, suprascapular nerve block (SSB) can be used as a safer alternative. In this prospective study, 60 ASA 1 or 2 adult patients undergoing shoulder arthroscopic surgery were randomised into two groups - ISB and SSB. In group ISB, ISB with 20ml of 0.5% bupivacaine mixed with 75μg clonidine was given. In the SSB group SSB was given with 15ml of 0.5% bupivacaine with 75μg clonidine. Pain was assessed using visual analogue scale and verbal pain scale scores and time to first rescue analgesia was noted. We used Student's t test and Chi-square/Fisher Exact test and used a statistical software to compare data. In the present study, the mean duration of analgesia was 2.53±2.26h in SSB group compared to 7.23±6.83h in group ISB (p value<0.05). Overall rescue analgesic requirements were higher in SSB group compared to ISB group (63.3% versus 40.0%) but this was statistically not significant (p value>0.05). Both interscalene and SSB can be used to provide intra-operative and post-operative analgesia in patients undergoing shoulder arthroscopy.

AB0879 Effects of Suprascapular Nerve Blockage on Pain and Functional Status in Adhesive Capsulitis: A Prospective Controlled Trial

BackgroundAdhesive capsulitis is a common disorder characterized by severe shoulder pain and progressive limitation of active and passive glenohumeral movements (1,2).ObjectivesThe aim of this study was to eveluate the effects...

A comparison of suprascapular nerve block and procedural sedation analgesia in shoulder dislocation reduction

ObjectivesDislocation of the shoulder joint is one of the most common dislocations. The reduction procedure is a painful procedure. In this study, 2 different treatment groups were compared for pain control during shoulder dislocation reduction. It was aimed to evaluate the differences between the groups in reduction, success, length of hospital stay, complications, side effects, patient-physician satisfaction, and ease of application. MethodsThe study was planned to be prospective and randomized. As procedural sedation analgesia (SA), titration of ketamine 1 to 2 mg/kg was administered intravenously to group 1. Suprascapular nerve block (SNB) was applied under ultrasound guidance (USG) to group 2. Conformity to normal distribution of variables was examined with the Kolmogorov-Smirnov test. The χ2 test and Fisher test were used to evaluate differences between the groups in categorical variables and the Mann-Whitney U test, and a value of P < .05 was accepted as statistically significant. ResultsThe study comprised a total of 41 patients; 20 in the group 1 and 21 in the group 2. No statistically significant difference was determined between the groups in terms of age (P = .916), sex (P = .972), reduction success (P = .540), and patient-physician satisfaction (P = .198). The time spent in the emergency department (ED) by patients in the SA group was signficantly longer compared with the SNB group. No side effects were observed in the SNB group. ConclusionsSuprascapular nerve block, which can be easily applied under USG in the ED, can be evaluated as a good alternative to SA in the reduction of shoulder dislocations.

A Comparison of Subacromial Bursae Block, Suprascapular Nerve Block and Interscalene Brachial Plexus Block after Arthroscopic Shoulder Surgery

Background: The aim of this study was to compare the analgesic efficacy of subacromial bursae block (LA), suprascapular nerve block (SSB), and interscalene brachial plexus block (ISB) after arthroscopic shoulder surgery. Methods: 91 patients scheduled to undergo an arthroscopic shoulder acromioplasty under GA in an outpatient setting were included. The patients were prospectively randomized into 4 groups: 1) interscalene brachial plexus block, 2) suprascapular nerve block, 3) subacromial bursae block, 4) control group for comparison. Pain scores (VAS), supplemental analgesia, and side effects were recorded in the recoveryroom, 4 hours and 24 hours after surgery. Results: Group ISB had significantly lower pain scores at rest in the postanesthesia care unit than the SSB group (p = 0.037) and the control group (p = 0.0313). The same results were seen 4 hours follow-up. The LA group had significantly lower pain scores at rest in the postanesthesia care unit than the control group (p = 0.046) and after 4 hours follow-up significantly lower pain scores than both the SSB group (p = 0.021) and the control group (p = 0.037). After 24 hours, there were no differences between the two groups. Conclusion: In this prospective, randomized, blinded study we demonstrated that a single-dose interscalene brachial plexus block (ISB) and a subacromial bursae block (LA) are equal and the most efficient analgesic techniques after arthroscopic shoulder acromioplasty. LA is less expensive, faster and with fewer complications than ISB and therefore we suggest subacromial bursae block is an effective, safe and easy way of postoperative pain reduction after arthroscopic acromioplasty. Level of evidence: Level I. Treatment study.

Suprascapular nerve block in the treatment of hemiplegic shoulder pain

ObjectiveThe aim of the study was to study the effectiveness of suprascapular nerve block (SSNB) in reducing pain and increasing range of motion (ROM) in hemiplegic shoulder pain and to compare them with therapeutic ultrasound (U/S).DesignThe study was designed as a randomized controlled trial.SettingThe study was conducted in the Department of Physical Medicine, Rheumatology and Rehabilitation.Patients and methodsStroke patients with hemiplegic shoulder pain who met the inclusion criteria were included in the present study and allocated to the SSNB or U/S groups. Both groups were given the same standard program of ROM exercise, and visual analog scale score of pain, passive maximum ROM, and Croft Disability Questionnaire at second and fourth weeks were evaluated.ResultsTwenty stroke patients were equally allocated to the SSNB and U/S groups. There was a significant improvement in visual analog scale scores and Croft Disability Questionnaire at the second and fourth weeks in the SSNB group. For ROM outcome of the SSNB group, the increase in flexion at the second and fourth weeks was 18.96 ± 11.73 and 34.93 ± 17.58 and in abduction was 22.26 ± 15.48 and 41.12 ± 22.02, respectively. SSNB produced faster relief of pain and more effective restoration of ROM compared with U/S.ConclusionThe present study suggested that SSNB is a safe and effective treatment for hemiplegic shoulder pain. It was more effective than therapeutic U/S in reducing pain score and improving ROM and upper limb function.

Suprascapular Nerve Block for Shoulder Pain in the First Year After Stroke

Shoulder pain is a common complication after stroke that can impede participation in rehabilitation and has been associated with poorer outcomes. Evidence-based treatments for hemiplegic shoulder pain are limited. Suprascapular nerve block (SSNB) is a safe and effective treatment of shoulder pain associated with arthritic shoulder conditions, but its usefulness in a stroke population is unclear. We undertook a randomized controlled trial assessing the effectiveness of SSNB in a population of 64 stroke patients (onset < 1 year) with hemiplegic shoulder pain. The primary outcome was pain measured on a visual analogue scale (VAS). Secondary outcomes were disability (Modified Rankin Scale, Croft Disability Index) and quality of life (EuroQol Health Questionnaire). All participants were assessed before randomization, and at 1, 4, and 12 weeks postintervention. Both groups continued with routine therapy. Although both intervention and control groups demonstrated reduction in pain score, participants who received SSNB consistently demonstrated superior, statistically significant pain reduction compared with placebo. Mean VAS reduction in the SSNB group was >18 mm greater than participants receiving placebo injection. The number needed to treat with SSNB to reduce 1 stroke survivor's pain by 50% at 4 weeks is 4. No significant differences in function or quality of life were observed. No adverse events were reported. Suprascapular nerve block is a safe and effective treatment for patients with hemiplegic shoulder pain. http://www.anzctr.org.au. Unique identifier: ACTRN12609000621213.

Randomized double-blind comparison of phrenic nerve infiltration and suprascapular nerve block for ipsilateral shoulder pain after thoracic surgery

Despite the use of thoracic epidural analgesia, a constant severe ache occurs in the ipsilateral shoulder of almost 75% of patients after thoracotomy. The aim of this prospective-randomized study was to investigate the effect of phrenic nerve infiltration (PNI) compared with suprascapular nerve block (SNB) on ipsilateral shoulder pain after thoracic surgery. After Local Research Ethics Committee approval, written informed consent was obtained from 90 adult patients undergoing thoracotomy for pulmonary resection. Patients were excluded if they had preexisting shoulder pain, were unable to understand the visual analog scale (VAS) scoring system or due to failure of epidural analgesia. The phrenic group (PNI) received 10 ml of 2% lidocaine infiltrated into the periphrenic fat pad, 1-2 cm close to the diaphragm, just before chest closure. The suprascapular group (SNB) received 10 ml of 0.5% plain bupivacaine injected into the suprascapular fossa once the surgery was finished. A blinded observer to the study group assessed the patient's shoulder and thoracotomy pain, using the VAS score and a five-point observer verbal rating score (OVRS), at 0.5, 1, 2, 3, 4, 5, 6, 12, 48, and 72 h after surgery and at discharge. The time and dose of any administered analgesic medication were recorded. Finally, 74 patients were included (37 per group). Sixteen patients were excluded (unable to understand scoring system, failure of the epidural technique, and lost data). There were no significant differences in age, gender, body mass index, type/duration of operation, and pain scores at rest, between the two groups. Shoulder pain intensity was significantly lower in the PNI group compared with the SNB group (median value of VAS area under the curve for the PNI group: 8.1 (0-70.9)cm vs 114.3 (43.8-193.8)cm for the SNB group; p < 0.001). There were no significant differences between the two groups according to postoperative thoracotomy pain. Phrenic nerve block with 2% lidocaine should be performed in all patients undergoing a major thoracic surgery procedure. These results strongly support the hypothesis that irritation of the pericardium and/or mediastinal-diaphragmatic pleural surfaces results in pain that is referred to the shoulder via the phrenic nerve.