Abstract
The suprascapular nerve (SSN) originates from the C5 and C6 nerve roots and provides
sensation for the posterior shoulder capsule, acromioclavicular joint, subacromial
bursa, and coracoclavicular ligament. Blocking it provides pre-emptive anesthesia,
decreased intraoperative pain, and postoperative pain relief in shoulder arthroscopy.
Under general anesthesia, 25 mL of 0.5% bupivacaine is injected by a spinal needle
placed 1 cm medial to the convergence of the spine and clavicle, angling toward the
coracoid. At a depth of 3 to 4 cm, the needle strikes the scapula body. The surgeon
probes with the needle anteriorly until the scapula is no longer felt, then moves
the needle back posteriorly until the bone is felt again. This places the needle at
the coracoid base in the supraspinatus fossa where the SSN curves around the coracoid
and heads to the glenohumeral joint. At this point, the anesthetic is injected, “flooding”
the SSN location. In addition to the SSN block, other pain-control procedures should
be performed, including bupivacaine injection of all portals and an intra-articular
injection of morphine sulfate at the end of the procedure. The SSN block is an effective
technique and can reduce postoperative medication needs and allow earlier patient
discharge from the surgery center.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Preoperative interscalene block for elective shoulder surgery.Anesth Analg. 2003; 97: 1620-1626
- Analgesic effect of interscalene block using low-dose bupivacaine for outpatient arthroscopic shoulder surgery.Reg Anesth Pain Med. 1998; 23: 469-473
- Interscalene anesthesia for shoulder arthroscopy in a community-sized military hospital.Arthroscopy. 1996; 12: 715-719
- Interscalene block for shoulder arthroscopy.Arthroscopy. 1993; 9: 295-300
- Comparison of intra-articular bupivacaine with the addition of morphine or fentanyl for analgesia after arthroscopic surgery.Arthroscopy. 1995; 11: 660-663
- Analgesic effect of intra-articular morphine, bupivacaine, and morphine/bupivacaine after arthroscopic knee surgery.Arthroscopy. 1994; 10: 104-107
- The efficacy of intra-articular morphine for postoperative knee arthroscopy analgesia.Arthroscopy. 1997; 13: 584-589
- The efficacy of cryotherapy in the postoperative shoulder.J Shoulder Elbow Surg. 1996; 5: 62-68
- Continuous flow cold therapy for outpatient ACL reconstruction.Arthroscopy. 1998; 14: 130-135
- The pain control infusion pump for postoperative pain control in shoulder surgery.Arthroscopy. 2000; 16: 339-342
- The effectiveness of an anesthetic continuous-infusion device on postoperative pain control.Arthroscopy. 2002; 18: 76-81
- Suprascapular nerve block.Reg Anesth. 1996; 21: 371-373
- Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery.Anesth Analg. 1997; 86: 217-218
- Suprascapular nerve block prolongs analgesia after nonarthroscopic shoulder surgery but does not improve outcome.Anesth Analg. 2003; 96: 982-986
- Suprascapular nerve block by a new anterior approach for perioperative analgesia during major scapular surgery in two patients.Reg Anesth Pain Med. 2001; 26: 288-289
- Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain.Ann Rheum Dis. 2003; 62: 400-406
- The use of combined suprascapular and circumflex (articular branches) nerve blocks in the management of chronic arthritis of the shoulder joint.Eur J Anaesthesiol. 1999; 16: 37-41
- Suprascapular nerve block by catheter for breakthrough shoulder cancer pain.Reg Anesth. 1995; 20: 343-346
- Suprascapular nerve block in the management of cancer pain.Anaesthesia. 1992; 47: 626
- Suprascapular nerve block for pain relief in adhesive capsulitis.Arch Phys Med Rehabil. 2002; 83: 593-597
- Double blind randomized clinical trial examining the efficacy of bupivacaine suprascapular nerve blocks in frozen shoulder.J Rheumatol. 2000; 27: 1464-1469
- Suprascapular nerve block.Reg Anesth Pain Med. 2004; 29: 75-76
- Arthroscopy of the shoulder.Orthop Clin North Am. 1987; 18: 361-372
- The new subclavian portal and modified Neviaser portal for arthroscopic rotator cuff repair.Arthroscopy. 2003; 19: 1030-1034
- Hemidiaphragmatic paresis during interscalene brachial plexus block.Anesth Analg. 1992; 74: 352-357
Article info
Footnotes
Cite this article as: Barber FA. Suprascapular nerve block for shoulder arthroscopy. Arthroscopy 2005;21:1015.e1-1015.e4, [doi:10.1016/j.arthro.2005.05.033].
Identification
Copyright
© 2005 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
