Korean J Pain.  2012 Jul;25(3):168-172. 10.3344/kjp.2012.25.3.168.

A New Anterior Approach for Fluoroscopy-guided Suprascapular Nerve Block: A Preliminary Report

• Kang SS
• Jung JW
• Song CK
• Yoon YJ
• Shin KM

• KMID: 2278151
• DOI: http://doi.org/10.3344/kjp.2012.25.3.168

Abstract

BACKGROUND
The aim of the study was to investigate the feasibility of fluoroscopy-guided anterior approach for suprascapular nerve block (SSNB).
METHODS
Twenty patients with chronic shoulder pain were included in the study. All of the nerve blocks were performed with patients in a supine position. Fluoroscopy was tilted medially to obtain the best view of the scapular notch (medial angle) and caudally to put the base of coracoid process and scapular spine on same line (caudal angle). SSNB was performed by introducing a 100-mm, 21-gauge needle to the scapular notch with tunnel view technique. Following negative aspiration, 1.0 ml of contrast was injected to confirm the scapular notch, and 1 % mepivacaine 2 ml was slowly injected. The success of SSNB was assessed by numerical rating scale (NRS) before and after the block.
RESULTS
The average NRS was decreased from 4.8 +/- 0.6 to 0.6 +/- 0.5 after the procedure (P < 0.05). The best view of the scapular notch was obtained in a medial angle of 15.1 +/- 2.2 (11-19degrees) and a caudal angle of 15.4 +/- 1.7degrees (12-18degrees). The average distance from the skin to the scapular notch was 5.8 +/- 0.6 cm. None of the complications such as pneumothorax, intravascular injection, and hematoma formation was found except one case of partial brachial plexus block.
CONCLUSIONS
SSNB by fluoroscopy-guided anterior approach is a feasible technique. The advantage of using a fluoroscopy resulted in an effective block with a small dose of local anesthetics by an accurate placement of a tip of needle in the scapular notch while avoiding pneumothorax.

Keyword

contrast media; fluoroscopy; nerve block; shoulder pain

MeSH Terms

Anesthetics, Local
Brachial Plexus
Contrast Media
Fluoroscopy
Hematoma
Humans
Imidazoles
Mepivacaine
Needles
Nerve Block
Nitro Compounds
Pneumothorax
Shoulder Pain
Skin
Spine
Supine Position
Anesthetics, Local
Contrast Media
Imidazoles
Mepivacaine
Nitro Compounds

Figure

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  Fig. 1 This figure shows fluoroscopic angulation for the anterior approach for suprascapular nerve. (A) Fluoroscopy was tilted medially (medial angle). (B) Fluoroscopy was tilted caudally (caudal angle).

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  Fig. 2 This figure shows fluoroscopic images of the anterior approach for suprascapular nerve block. (A) Optimal fluoroscopic image for SSNB. (B) Contrast material suffusing through the suprascapular notch. (C) In case of radioopacification of supraspinatus muscle, the needle was withdrawn with 0.5 cm incrementally and 0.5 ml of contrast was injected until the scapular notch was radioopacified. CP: coracoids process, SN: suprascapular notch, SS: scapular spine, ssm: supraspinatus muscle.

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