Supraspinatus plane block: A novel approach to suprascapular nerve block for rotator cuff repair

• Published in: Journal of clinical anesthesia 2019-11, Vol.57, p.20-21
• Main Authors: Kalava, Arun, Arslan, Orhan E., McClain, Robert L.
• Format: Article
• Language: English
• Subjects: Alcohol; Anesthesia; Arthroscopy - methods; Humans; Male; Middle Aged; Nerve Block - methods; Pain; Rotator cuff; Rotator Cuff - surgery; Shoulder; Surgery; Ultrasonic imaging; Ultrasonography, Interventional - methods
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2019.02.023

Supraspinatus plane block, we believe might eliminate the risk of pneumothorax with a higher net margin of safety and provide non-inferior analgesia after shoulder arthroscopy. Since the suprascapular nerve courses beneath the trapezius muscle, before reaching the suprascapular notch, we hypothesized that depositing local anesthetic inferior to the trapezius muscle and above the supraspinatus muscle, might allow an effective blockade of the suprascapular nerve. A 22G 5 cm graduated Tuohy needle (StimuQuick®, Arrow, Teleflex Medical, Athlone, Ireland) was used in an out-of-plane approach to reach the inter-muscular fascial plane between the trapezius and the supraspinatus muscle, with the tip lying lateral to the transverse cervical vessels. 0.9% saline was used to confirm and expand the inter-muscular fascial plane, after which 20 ml of 0.5% ropivacaine was injected in 5 ml increments after negative aspiration of blood. [...]this technique like other plane blocks can perform with an indwelling catheter if an extended duration of pain relief is warranted. Since this is a single patient case report, we cannot generalize that this technique is equivalent to traditional techniques to block the suprascapular nerve without direct comparison in a larger surgical population.