Suprascapular Nerve Block Research Articles

Phrenic Sparing Shoulder Block: A Case Report

Interscalene block is used for shoulder surgeries however it almost always results in phrenic nerve palsy1,2. Some anaesthesiologists have described careful ultrasound guided low volume (5mls only) of local anesthetic interscalene block which does not cause hemidiaphragmatic paresis3. However we present to you a case where we implied a recently described technique of phrenic sparing involving a combination of oblique infraclavicular brachial plexus block with subomohyoid suprascapular nerve block. Keywords: Shoulder block, phrenic nerve palsy,

Suprascapular Nerve Block (SSNB) improves the outcome in exercise based management of Primary Adhesive Capsulitis (PAC): A prospective randomized comparative study.

Increased pain and associated stiffness hinders the advantages of exercise and process of recovery in primary adhesive capsulitis. We hypothesized that suprascapular nerve block may positively affect the outcome due to its role in pain relief of acute or chronic shoulder pain. We compared the effect of suprascapular nerve block and exercise with only exercise on the recovery of primary adhesive capsulitis. A total of 96 patients of both sexes presenting with primary adhesive capsulitis were divided by computer randomization in two equal groups (n = 48). Group A received exercise only and Group B received suprascapular nerve block followed by exercise. Oral paracetamol was given for analgesia as desired. Patients were followed up at 4, 8, 16, and 24 weeks. Pain was assessed by visual analog scale; functional outcome by Shoulder Pain and Disability Index and range of movement by goniometer. The pain scores and Shoulder Pain and Disability Index scores were significantly lower at all observation points of 4, 8,16, and 24 weeks in Group B than Group A (P < 0.05). The range of movement in all the ranges of forward flexion, extension, internal and external rotation, and abduction at all observation points was significantly higher in Group-B (P < 0.05) compared to Group A. The consumption of analgesics was significantly more in Group A than Group B at 4 and 8 weeks (P = 0.020 and P = 0.044) but comparable at 12 and 24 weeks (P = 0.145 and P = 0.237 respectively). Combining SSNB with exercise is more effective in treatment of primary adhesive capsulitis than exercise alone and reduces the use of analgesics. SSNB it is effective and safe to use in primary adhesive capsulitis.

Does the application of pulse radiofrequency to the suprascapular nerve provide additional benefit in patients who have undergone glenohumeral intra-articular steroid injection and suprascapular nerve block?

Shoulder pain is one of the most common musculoskeletal pain syndromes. Interventional treatments can be applied to patients who do not respond to conservative therapies. Intra-articular steroid injection and suprascapular nerve block are both short-acting and may sometimes be clinically inadequate. In this study, the answer to the question of whether pulse radiofrequency application to the suprascapular nerve provides additional benefit was investigated. Patients who had shoulder pain and were injected between October 2016 and April 2018 were evaluated retrospectively. Totally 160 patients who underwent shoulder injections were included in the study. Patients were divided into two groups: 114 patients who underwent shoulder intra-articular steroid injection and suprascapular nerve block, as Group 1 and 46 patients who underwent pulse radiofrequency to the suprascapular nerve, in addition to shoulder intra-articular steroid injection and suprascapular nerve block, as Group 2. There was no statistical difference between the groups in pre-intervention numerical rating scale (NRS) scores. One month after the intervention, NRS scores of Group 2 were significantly lower than Group 1. In both groups, 1 month after the intervention NRS scores were significantly lower than pre-intervention. The duration of pain relief for Group 2 was longer than Group 1. The satisfaction percentages of patients for Group 2 were higher than Group 1. In addition to glenohumeral intra-articular steroid injection and suprascapular nerve block, pulse radiofrequency application to the suprascapular nerve provides additional benefits in terms of NRS scores, duration of pain relief, and patient satisfaction.

The role of suprascapular nerve block in hydrodilatation for frozen shoulder.

Introduction: Frozen shoulder is a debilitating problem that requires comprehensive diagnosis and management. Patients usually recover, but the possibility of not reobtaining a full range of motion exists. Thus, early shoulder exercises are necessary to achieve their full range of motion. This study aims to understand the effects of suprascapular nerve block (SSNB) augmentation at the spinoglenoid notch in hydrodilatation to treat frozen shoulder to facilitate early shoulder exercises. Methods: The current study retrospectively observed 31 patients, including 40–60-year-old patients diagnosed and treated with primary frozen shoulder. The participants were divided into groups A (hydrodilatation) and B (hydrodilatation and the augmentation of an SSNB). Shoulder function and pain scores were assessed before, during, and after the intervention (at months 1 and 6). Results: The result of this study shows that suprascapular nerve block plays a role in decreasing pain in intraintervention (0.69 vs. 5.73; p < 0.05), month 1 of follow-up (3.44 vs. 6.40; p < 0.05), but not significant on month 6 of group A and B after intervention (5.88 vs. 7.20; p > 0.05). Better delta functional scores were noted in the therapy group during month 1 of the follow-up (delta American shoulder and elbow surgeons [ASES]: 19.29 vs. 34.40, p < 0.05; delta disabilities of the arm, shoulder, and hand [DASH]: 17.88 vs. 38.15, p < 0.05). The difference in functional score on month 6 between both groups was not significantly different (delta ASES: 31.97 vs. 30.31, p > 0.05; delta DASH: 36.63 vs. 38.92, p > 0.05). Discussion: One rationale for using an SSNB augmentation at spinoglenoid notch in hydrodilatation for treating frozen shoulder was to obtain pain relief immediately to facilitate early manual exercise. SSNB has positive effects on short-term evaluation of shoulder pain and function after glenohumeral hydrodilatation, but not in the long term.

Current Concepts in Regional Analgesia Techniques for Postoperative Pain Management after Total Shoulder Arthroplasty: A Narrative Review

Postoperative pain management after total shoulder arthroplasty (TSA) can be challenging. Interscalene brachial plexus block, which is administered either as since injection (ssISB) or with continuous catheter (ccISB) technique, is the gold standard. Ultrasonography (USG) guidance facilitates a faster, more accurate block with a lower local anaesthetic volume in ssISB. USG also helps for accurate catheter placement in ccISB. Hemi-diaphragmatic palsy is a common complication of ISB. This can be a major concern for patients with a respiratory compromise so it necessitates the administration of diaphragm-sparing nerve blocks. Phrenic nerve sparing block like suprascapular nerve block (SSNB) singly or along with axillary nerve block, subomohyoid anterior suprascapular block, superior trunk block, erector spinae plane block, individually, provide perioperative analgesia non-inferior to ISB. Subacromial or intraarticular infiltration of local anaesthesia (SAIA) is not recommended due to its limited clinical efficacy. Extended analgesic effects have been observed with liposomal bupivacaine when used as a field block. This article provides an overview of regional anaesthesia techniques for postoperative analgesia following Total shoulder arthroplasty (TSA) Keywords: Shoulder arthroplasty, Pain management, Regional anaesthesia, Interscalene brachial plexus block

Does Ultrasound-Guided Continuous Suprascapular Nerve Block Affect Frozen Shoulder Rehabilitation Programme Outcome?

Does Ultrasound-Guided Continuous Suprascapular Nerve Block Affect Frozen Shoulder Rehabilitation Programme Outcome?

A COMPARISON OF SUPRASCAPULAR NERVE BLOCK VS INTRAARTICULAR STEROID INJECTION IN IMPROVEMENT OF HEMIPLEGIC SHOULDER PAIN

Objectives: To compare the mean improvement in pain on Visual Analogue Scale by Suprascapular Nerve block and Intra-articular steroid injection in patients with hemiplegic shoulder pain.&#x0D; Study Design: Randomized Controlled Trial&#x0D; Place and Duration of Study: Pain Clinic, Armed Forces Institute of Rehabilitation Medicine Rawalpindi from 25th October 2017 to 24th April 2018&#x0D; Patients &amp; Methods: 60 patients with CVA and shoulder pain on hemiplegic side for at least 2 weeks were included in study after non-probability consecutive sampling after meeting inclusion criteria. Subjects were randomized by lottery into two groups; Group A receiving Suprascapular Nerve block with 5ml of 1% Lignocaine with Group B receiving Intra-articular 40mg Triamcinolone Acetonide plus 1 ml of 1% Lignocaine injections. Mean change in pain scores on VAS was calculated between score at baseline and at 4 weeks post-intervention&#x0D; Results: The mean age of patients in group A was 59.17 ± 9.81 years and in group B was 39.96 ± 11.11 years. Out of 60 patients, 34 (56.67%) were males and 26 (43.33%) were females with male to female ratio of 1.3:1. Mean duration of stroke was 7.50 ± 2.66 months. Mean pain change on VAS in Group A (Suprascapular Nerve block) was 3.83 ± 1.12 cm while in Group B (Intra-articular steroid injection) it was 2.17 ± 0.99 cm (p-value = 0.0001).&#x0D; Conclusion: This study concluded that Suprascapular Nerve block offered better improvement in hemiplegic shoulder pain on Visual Analogue Scale at 4 weeks as compared to intraarticular steroid injection.

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.

Clinical effects of suprascapular nerve block in addition to intra-articular corticosteroid injection in the early stages of adhesive capsulitis: A singleblind, randomized controlled trial.

The aim of this study was to evaluate the short and long-term effects of the combination of suprascapular nerve block (SSNB) and intra-articular corticosteroid injection (IAI) on pain, shoulder range of motion (ROM), disability, and quality of life in the management of patients with adhesive capsulitis (AC). Forty patients (ages 30-70 years) who were diagnosed with AC stages 1 and 2 were randomlyassigned to one of two groups: Group-1 received IAI and SSNB combination, while group-2 only-IAI. Both groups started a three-week rehabilitation program after the intervention. The Shoulder Pain and Disability Index (SPADI), Numeric Rating Scale (NRS), active and passive shoulder ROMs, and the Short Form 36(SF-36) were assessed by a physiatrist who was blinded to the allocation at baseline and three weeks, three months, and twelve months. The NRS and shoulder ROMs were also examined in the first hour. Nineteen patients from each group with mean ages of 55.84±2.19 (15 females, 4 males) and51.79 ± 1.58 (14 females, 5 males) were included. Within the groups, SPADI and NRS scores were decreased, while active and passive ROMs and the physical function, physical role, and bodily pain domains of SF-36 were increased by time (P < 0.05). Between the groups, the change in NRS value and active flexion in the first hour was more remarkable in group 1 (P < 0.05). No significant difference between outcome measurements was found at the 3rd week, 3rd month, and 12th month (P > 0.05). SSNB as an adjunct to IAI in AC positively affected the immediate pain relief and functional improvement after the intervention; however, it did not yield any additional benefit in the short and long-terms. Level I, Therapeutic Study.

Application of Dexmedetomidine Sedation Combined With Suprascapular Nerve Block and Axillary Nerve Block in Shoulder Arthroscopy, A Randomized Single-Blind Study.

Objective: The aim of the present study was to evaluate the anesthetic and analgesic effects of dexmedetomidine combined with suprascapular nerve block and axillary nerve block in shoulder arthroscopy. Methods: A total of 60 patients were randomly divided into the experimental group (DEX group) and the control group (GA group) via a random number table method. Dexmedetomidine sedation combined with suprascapular nerve block and axillary nerve block was used in the DEX group, while general anesthesia with tracheal intubation combined with interscalene brachial plexus block was used in the GA group. The perioperative indexes, intraoperative hemodynamics, cerebral oxygen saturation, and postoperative pain score, as well as any complications, were compared between the two groups. Results: The anesthesia duration (p < 0.05) and postoperative monitoring time (p < 0.05) in the DEX group were significantly shorter than those in the GA group. At most time points during the anesthesia, the cerebral oxygen saturation (p < 0.05) and mean arterial pressure (p < 0.05) in the DEX group were significantly higher than those in the GA group. Additionally, the decrease in the cerebral oxygen saturation and mean arterial pressure in the GA group was significantly higher than that in the DEX group (p < 0.05). The pain score of DEX group 12 h after operation significantly lower than that in the GA group (p < 0.05), and the incidence of postoperative hypoxemia along with nausea and vomiting in the GA group was significantly higher than that in the DEX group (p < 0.05). Conclusion: Dexmedetomidine combined with suprascapular nerve block and axillary nerve block could reduce the incidence of hypoxemia, while the approach demonstrated better hemodynamic stability, fully ensured the cerebral blood perfusion, and exhibited better anesthetic and analgesic effects, meaning it could be safely and effectively applied in shoulder arthroscopy procedures.

The Impact of Suprascapular Nerve Interventions in Patients with Frozen Shoulder: A Systematic Review and Meta-Analysis.

Frozen shoulder is a common condition resulting in severe pain and restricted range of motion. An assessment of the effectiveness of interventions may provide an improved understanding of the development and management of frozen shoulder. A literature search was conducted using Embase, the Cumulative Index of Nursing and Allied Health (CINAHL), the Cochrane Central Register of Controlled Trials (CENTRAL), and National Center for Biotechnology Information PubMed using relevant terms. Studies were included if they assessed the outcomes of interventions on the suprascapular nerve that aim to improve the symptoms of frozen shoulder. A database search returned 196 articles. After review, 9 articles met the inclusion criteria and were included in the analysis. Suprascapular nerve interventions (nerve block, pulsed radiofrequency lesioning) are associated with improvement in pain, motion, and function. Meta-analysis showed that pain (Hedges g, -3.084 [95% confidence interval (CI), -4.273 to -1.894]; p < 0.001) and range of motion (Hedges g, 2.204 [95% CI, 0.992 to 3.415]; p < 0.001) improved significantly following suprascapular nerve block (SSNB). SSNB is associated with significant improvements in shoulder pain and range of motion in patients with frozen shoulder. Further randomized controlled trials comparing SSNB with intra-articular injection and other nonoperative treatments are required to fully define its role in the management of frozen shoulder. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Unprecedented emergencies during radiofrequency ablation procedure: a case series

Radiofrequency ablation (RFA) of nerves is an upcoming intervention for relieving chronic musculoskeletal pain. However, being relatively new not much publications are available on emergencies during the procedure. 66 years old male, a case of Osteoarthritis knee, underwent RFA genicular nerve of right knee. Conventional RFA of Superolateral, Inferomedial, Superomedial genicular nerves were done under C- arm guidance. Thirty minutes after the procedure, we found a boggy swelling developing over his right knee. It was a hematoma developing on the superomedial aspect of the right kneecap most likely due to injury to Superomedial genicular vessels accompanying the nerve. 67 years old female planned for RFA genicular nerves of both knees under C arm guidance. During the intervention, she complained of numbness around face, and suddenly went into disoriented state with muscle twitching and bluish discoloration of lips. Medicine consultation diagnosed the incident as LA associated systemic toxicity. 57 years old female with chief complaints of pain in left hemiplegic shoulder pain for 6 months duration admitted for suprascapular nerve block. During the procedure patient goes into hypotensive bradycardic episode. 65 years old female admitted for Medial calcaneal block for right heel pain. 24 hours after the procedure she has aggravated pain of foot. RFA is considered as a non-invasive, OPD based procedure for effective pain relief but it is also important to understand such unprecedented emergencies that can happen.

Suprascapular nerve block and axillary nerve block versus interscalene nerve block for arthroscopic shoulder surgery: A meta-analysis of randomized controlled trials.

Background:The 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) and axillary Nerve Block (ANB) has been reported as an alternative nerve block with fewer reported side effects for shoulder arthroscopy. This review aimed to compare the impact of SSNB and ANB with ISB during shoulder arthroscopy surgery.Methods:A meta-analysis was conducted to identify relevant randomized or quasirandomized controlled trials involving SSNB and ISB during shoulder arthroscopy surgery. We searched Web of Science, PubMed, Embase, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CNKI, and Wanfang database from 2010 through August 2021.Results:We identified 641 patients assessed in 10 randomized or quasirandomized controlled trials. Compared with the ISB group, the SSNB+ANB group had higher visual analog scale or numerical rating scale in PACU (P = .03), 4 hour (P = .001),6 hour after the operation (P = .002), and lower incidence of complications such as Numb/Tingling (P = .001), Weakness (P <.00001), Horner syndrome (P = .001) and Subjective dyspnea (P = .002). No significant difference was found for visual analog scale or numerical rating scale 8 hour (P = .71),12 hour (P = .17), 16 hour (P = .38),1day after operation (P = .11), patient satisfaction (P = .38) and incidence of complications such as hoarseness (P = .07) and nausea/vomiting (P = .41) between 2 groups.Conclusion:Our high-level evidence has established SSNB+ ANB as an effective and safe analgesic technique and a clinically attractive alternative to interscalene block 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 randomized controlled trial studies with long-term follow-up to reach a firmer conclusion.

Evaluation of Interfascial Plane and Pericapsular Nerve Blocks to the Shoulder Joint: A Preliminary Analysis of Shoulder Anterior Capsular Block.

IntroductionThe aim of this study is to verify if the shoulder anterior capsular block (SHAC), combined with other nerve blocks, is effective in relieving shoulder pain, avoiding motor block and allowing an early rehabilitation program.MethodsSeventy-five consecutive patients with painful shoulder were treated with the SHAC, alone (30 patients) or in combination with a suprascapular nerve block (SSnb: 25 patients) or with pectoralis and serratus plane block (PECS-2: 20 patients). All blocks were performed with 0.2% ropivacaine plus 8 mg dexamethasone. All patients were treated with three-weekly physiotherapy sessions for the following 2 weeks and then with home exercises.ResultsThe post-procedural analgesic effect was strong in all groups, with a mean change in numeric rating scale (NRS) values of −6.05 in group 1, −6.25 in group 2, and −6.19 in group 3 (p < .0001), allowing all patients to complete an immediate physiotherapy session. Only a few patients needed to repeat the procedure 1 week after the first treatment for the recurrence of pain. From the treatment to the end of the follow-up, we noted a further drop in mean pain NRS values of 1.90 in group 1 and 1.80 in groups 2 and 3. No difference in effect over time was observed among the different groups. No adverse event or motor block was recorded.ConclusionThis study demonstrates that the SHAC, alone or in combination with other peripheral nerve blocks, is an attractive alternative for shoulder pain management, especially when physiotherapy is required to recover shoulder function.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-021-00326-0.

Manipulation under local anaesthesia for idiopathic adhesive capsulitis

Adhesive capsulitis which is said to be a self limiting diseases is manipulated under anaesthesia and this process has been used to speed up the recovery of the disaese. Twenty six patients with idiopathic unilateral frozen shoulder underwent suprascapular nerve block and intraarticular local anesthesia with Methyl prednisolone acetate followed by manipulation of the glenohumeral joint and this randomized prospective clinical trial was performed in bone and joints hospital Barzulla Srinagar Kashmir. Differences in range of motion and pain were assessed before manipulation and at first week; 4th week; 8th week; 6 weeks and 12weeks. Passive range of motion increased significantly for forward flexion, abduction, external rotation, and internal rotation. There was a significant decrease in visual analogue pain (VAS) scores between initial and follow-up assessments. This technique is very simple, safe, cost effective and minimally invasive procedure for shortening the course of an apparently self-limiting disease and improves shoulder symptoms and function.

Ultrasound-guided pulsed radiofrequency for chronic shoulder pain: a prospective study

Background and objectivesChronic shoulder pain is a frequent cause of suffering and impaired quality of life. Treatment includes non-pharmacological and pharmacological therapies, and interventional procedures such as suprascapular nerve blocks and radiofrequency. This prospective study aims to evaluate the efficacy of ultrasound-guided pulsed radiofrequency of suprascapular nerve for chronic shoulder pain in a clinical setting. MethodsTherapeutic efficacy was evaluated through pain intensity using numeric pain rating scale at baseline, immediately, 3, and 6 months after, and patient...s motor function improvement. The secondary outcome was patient satisfaction. ResultsA total of 34 patients were enrolled and all patients presented a reduction in the numeric pain rating scale immediately after treatment. Pain reduction from baseline to 6 months after the procedure was 34.4% and 36.9% static and dynamic, respectively. The median percentage reduction was statistically significant immediately, 3 and 6 months after. There was also an improvement in range of motion, 39.6% in abduction, 24.1% in flexion, and 29.5% in extension. Ninety percent of patients reported patient...s global impression of change superior to six. ConclusionThis study concludes that ultrasound-guided pulsed radiofrequency of suprascapular nerve reduces pain intensity for at least 6 months, accompanied by improvement of motor function and higher levels of patients... satisfaction. Therefore, this technique represents a valid analgesic approach to chronic shoulder pain.

Anterior suprascapular nerve block versus interscalene brachial plexus block for arthroscopic shoulder surgery: a systematic review and meta-analysis of randomized controlled trials.

This systematic review aimed to compare the analgesic effectiveness and complications rates for anterior suprascapular nerve blocks (ASSB) compared to interscalene brachial plexus blocks (ISB) for arthroscopic and outpatient shoulder surgery. Only randomized controlled trials (RCTs) comparing the ASSB versus ISB in the context of arthroscopic shoulder surgery were eligible for inclusion. The primary outcomes included pain scores (Numeric Rating Scale of 0 to 10) up to 24h postoperatively and analgesic consumption. Secondary outcomes included block complications. Meta-analysis was performed using random-effects modeling and result certainty was determined using the GRADEpro tool. Six RCTs (709 patients) were included for analysis. ISB displayed a statistically significant reduction in pain scores by 0.40 (95%CI = 0.36 to 0.45; p < 0.00001) but not morphine equivalent consumption (mean difference = 0.74mg; 95%CI = -0.18 to 1.66mg; I2 = 60%; p = 0.11; moderate certainty) immediately in the postoperative care unit. Opioid consumption and pain scores at 6 to 24h were not significantly different. There was no difference in respiratory events postblock. ASSB demonstrated a significantly lower incidence of Horner's syndrome (relative risk (RR) = 0.17; 95%CI = 0.08 to 0.39; p < 0.00001; high certainty), voice hoarseness (RR = 0.24; 95%CI = 0.10 to 0.57; p < 0.00001; high certainty) and impaired respiratory function (p < 0.00001). The ASSB could be considered an appropriate analgesic option for arthroscopic shoulder surgery with potentially fewer complications than the ISB.

Cadaveric study investigating the phrenic-sparing volume for anterior suprascapular nerve block

BackgroundThis cadaveric study investigated the maximum effective volume of dye in 90% of cases (MEV90), required to stain the suprascapular nerve while sparing the phrenic nerve during the performance of...

Comparative Effectiveness of Injection Therapies for Hemiplegic Shoulder Pain in Stroke: A Systematic Review and Network Meta-Analysis.

Hemiplegic shoulder pain (HSP) hampers post-stroke functional recovery and is not well managed with conservative treatments. This systematic review aimed to examine the various injection therapies for HSP and investigate their effectiveness at different time points. The protocol of this meta-analysis was registered on INPLASY with a registration number of INPLASY202180010. PubMed, EMBASE, and Scopus were searched from their inception to 4 August 2021 for the clinical studies investigating comparative effectiveness of different injection regimens for treating hemiplegic shoulder pain in patients with stroke. The primary outcome was the weighted mean difference (WMD) on the visual analog scale (VAS) of pain reduction in the fourth-week and between the fourth and twenty-fourth weeks. Ranking probabilities of the WMD for each treatment were obtained using simulations. Seventeen studies with 595 participants were included. The network meta-analysis showed that at the fourth-week, intra-muscular botulinum toxin (BoNT) injections and suprascapular nerve blocks (SSNB) were superior to a placebo, with WMDs of 1.55 (95% CI, 0.09 to 3.01) and 1.44 (95% CI, 0.07 to 2.80), respectively. SSNB possessed the highest probability (53.3%) and appeared to be the best treatment in the fourth-week, followed by intra-muscular BoNT injections (42.6%). Intramuscular BoNT injections were better than the placebo, with a WMD of 1.57 (95% CI, 0.30 to 2.84) between the 4th and 24th weeks. Intramuscular BoNT injections had the highest probability (79.8%) as the best treatment between the 4th and 24th weeks. SSNB was likely to rank first in relieving HSP at the fourth post-treatment week, whereas intra-muscular BoNT injections had the highest probability to achieve the best treatment effectiveness in the post-injection period between the fourth and twenty-fourth weeks. However, as some of the included studies used a non-randomized controlled design, more randomized controlled trials are needed in the future to validate and better understand the short- and long-term efficacy of different injection therapies for management of HSP.

In Pursuit of Phrenic Nerve-Sparing Regional Anesthesia For Awake Shoulder Manipulation In Patients With Adhesive Capsulitis

Introduction. While interscalene brachial plexus block remains the gold standard of any shoulder procedure, including shoulder manipulation in patients with adhesive capsulitis, anesthesiologists are reluctant to face the risk of phrenic nerve paresis, especially in patients with preexisting pulmonary conditions. Hence, many studies have targeted specific regional anesthesia of the shoulder low enough by the blockade level, leaving phrenic nerve function intact but still providing satisfying anesthesia for shoulder procedures. Until recently, no comparison between these regional anesthesia techniques focusing on shoulder manipulation for adhesive capsulitis has been published. Case Report. We compared the profiles between suprascapular nerve block, shoulder interfascial plane block, and superior trunk block as the sole anesthesia technique in patients with adhesive capsulitis undergoing awake shoulder manipulation. Conclusion. This report descriptively signifies superior trunk block excellence among other regional anesthesia techniques in achieving complete anesthesia for awake shoulder manipulation in patients with adhesive capsulitis while sparing the phrenic-nerve function