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Ultrasound-Guided Versus Landmark-Based Approach to the Distal Suprascapular Nerve Block: A Comparative Cadaveric Study.
Arthroscopy. 2019 08; 35(8):2274-2281.A

Abstract

PURPOSE

To compare the accuracy of distal suprascapular nerve (dSSN) blockade performed with the use of ultrasound-guided regional anesthesia (USRA) versus with a landmark-based approach (LBA). A secondary aim was to describe the anatomic features of the sensory branches of the dSSN.

METHODS

USRA and LBA were performed in 15 shoulders each from 15 cadavers (total of 30 shoulders). Then, 10 mL of methylene blue‒infused ropivacaine 0.75% was injected into the dSSN. Simultaneously, 2.5 mL of red latex solution was injected to identify the position of the needle tip. The division and distribution of the sensory branches originating from the SSN were described.

RESULTS

The tip of the needle was identified at 1.3 cm (range, 0-5.2 cm) and 1.5 cm (range, 0-4.5 cm) with USRA and the LBA, respectively (P = .90). Staining diffused past the origin of the most proximal sensory branch in 27 cases. The most proximal sensory branch arose 2.5 cm from the suprascapular notch. Among the 3 failures that occurred in the USRA group, the sensory branches also failed to be marked. All 30 dSSNs gave off 3 sensory branches, which innervated the posterior glenohumeral capsule, the subacromial bursa, and the coracoclavicular and acromioclavicular ligaments.

CONCLUSIONS

An LBA is as reliable and accurate as US guidance for anesthetic blockade of the dSSN. Marking of the suprascapular nerve must be proximal to the suprascapular notch to involve the 3 sensory branches in the anesthetic blockade.

CLINICAL RELEVANCE

The present study demonstrates that a landmark-based approach to anesthetic blockade of the distal suprascapular nerve is accurate and can be performed by orthopaedic surgeons lacking experience in ultrasound-guided anesthetic techniques.

Authors+Show Affiliations

Anatomy Laboratory, Paul Sabatier-Toulouse III University, Toulouse, France; Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France. Electronic address: laumonerie.pierre@hotmail.fr.Department of Orthopaedic Surgery, Centre Hospitalier Universitaire de Reims, Reims, France.Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, U.S.A.Department of Anesthesiology, Centre Hospitalier Universitaire de Reims, Reims, France.Anatomy Laboratory, Paul Sabatier-Toulouse III University, Toulouse, France.Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France.Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France.Department of Orthopaedic Surgery, Centre Hospitalier Universitaire de Reims, Reims, France.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

31350084

Citation

Laumonerie, Pierre, et al. "Ultrasound-Guided Versus Landmark-Based Approach to the Distal Suprascapular Nerve Block: a Comparative Cadaveric Study." Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, vol. 35, no. 8, 2019, pp. 2274-2281.
Laumonerie P, Blasco L, Tibbo ME, et al. Ultrasound-Guided Versus Landmark-Based Approach to the Distal Suprascapular Nerve Block: A Comparative Cadaveric Study. Arthroscopy. 2019;35(8):2274-2281.
Laumonerie, P., Blasco, L., Tibbo, M. E., Panagiotis, K., Fernandes, O., Lauwers, F., Bonnevialle, N., Mansat, P., & Ohl, X. (2019). Ultrasound-Guided Versus Landmark-Based Approach to the Distal Suprascapular Nerve Block: A Comparative Cadaveric Study. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 35(8), 2274-2281. https://doi.org/10.1016/j.arthro.2019.02.050
Laumonerie P, et al. Ultrasound-Guided Versus Landmark-Based Approach to the Distal Suprascapular Nerve Block: a Comparative Cadaveric Study. Arthroscopy. 2019;35(8):2274-2281. PubMed PMID: 31350084.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ultrasound-Guided Versus Landmark-Based Approach to the Distal Suprascapular Nerve Block: A Comparative Cadaveric Study. AU - Laumonerie,Pierre, AU - Blasco,Laurent, AU - Tibbo,Meagan E, AU - Panagiotis,Kerezoudis, AU - Fernandes,Olivier, AU - Lauwers,Frederic, AU - Bonnevialle,Nicolas, AU - Mansat,Pierre, AU - Ohl,Xavier, Y1 - 2019/07/23/ PY - 2018/09/24/received PY - 2019/02/21/revised PY - 2019/02/28/accepted PY - 2019/7/28/pubmed PY - 2019/7/28/medline PY - 2019/7/28/entrez SP - 2274 EP - 2281 JF - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association JO - Arthroscopy VL - 35 IS - 8 N2 - PURPOSE: To compare the accuracy of distal suprascapular nerve (dSSN) blockade performed with the use of ultrasound-guided regional anesthesia (USRA) versus with a landmark-based approach (LBA). A secondary aim was to describe the anatomic features of the sensory branches of the dSSN. METHODS: USRA and LBA were performed in 15 shoulders each from 15 cadavers (total of 30 shoulders). Then, 10 mL of methylene blue‒infused ropivacaine 0.75% was injected into the dSSN. Simultaneously, 2.5 mL of red latex solution was injected to identify the position of the needle tip. The division and distribution of the sensory branches originating from the SSN were described. RESULTS: The tip of the needle was identified at 1.3 cm (range, 0-5.2 cm) and 1.5 cm (range, 0-4.5 cm) with USRA and the LBA, respectively (P = .90). Staining diffused past the origin of the most proximal sensory branch in 27 cases. The most proximal sensory branch arose 2.5 cm from the suprascapular notch. Among the 3 failures that occurred in the USRA group, the sensory branches also failed to be marked. All 30 dSSNs gave off 3 sensory branches, which innervated the posterior glenohumeral capsule, the subacromial bursa, and the coracoclavicular and acromioclavicular ligaments. CONCLUSIONS: An LBA is as reliable and accurate as US guidance for anesthetic blockade of the dSSN. Marking of the suprascapular nerve must be proximal to the suprascapular notch to involve the 3 sensory branches in the anesthetic blockade. CLINICAL RELEVANCE: The present study demonstrates that a landmark-based approach to anesthetic blockade of the distal suprascapular nerve is accurate and can be performed by orthopaedic surgeons lacking experience in ultrasound-guided anesthetic techniques. SN - 1526-3231 UR - https://www.unboundmedicine.com/medline/citation/31350084/Ultrasound_Guided_Versus_Landmark_Based_Approach_to_the_Distal_Suprascapular_Nerve_Block:_A_Comparative_Cadaveric_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-8063(19)30214-2 DB - PRIME DP - Unbound Medicine ER -