The suprascapular nerve originates from the C5 and C6 nerve roots of the upper trunk of the brachial plexus with a contribution from C4 usually present as well. The suprascapular nerve descends posteriorly, passing through the scapular notch and innervating the supraspinatus muscle and more distally the infraspinatus muscle. It also gives off sensory branches to the shoulder joint. Blocking this nerve prior to shoulder arthroscopy provides preemptive anesthesia and can decrease the postoperative pain. The technique for this block is straightforward. Palpate the “soft spot” medial to the junction of the scapular spine and clavicle. This is at the area of the Neviaser portal. Insert the needle at this site and angled toward the coracoid process. At a depth of about 3 to 4 centimeters, the needle will strike the body of the scapula. Probe with the needle anteriorly until the scapula is no longer felt. Then move the needle back posteriorly until the bone is felt again. This is the area at the base of the coracoid where the suprascapular nerve is located. Flood this area with anesthetic to block the nerve. The procedure code used is 64418-59. This simple technique has been used clinically for over one year with consistently good results. Postoperative medication requirements are reduced and patients leave the surgery center in less time. The technique will be demonstrated.
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© 2004 Published by Elsevier Inc.
