ULTRASOUND-GUIDED SUPRASCAPULAR NERVE BLOCK FOR PATIENTS WITH
PERSISTENT SHOULDER PAIN
Sultan J, Wilson J, Glover J, Goodyear E, Narendran U, Roy B.Trafford General Hospital
Introduction
70% of pain sensation around the shoulder is transmitted via the suprascapular nerve
Suprascapular nerve block (SSNB) has been previously described as a method of controlling pain from the shoulder (rheumatology clinics)
Bedside ultrasound-guided nerve blocks
Aim
To assess the efficacy of ultrasound-guided suprascapular nerve block for pain control in a group of patients with persistent shoulder pain and reduced function.
Methods Two experienced
anaesthetists; High-resolution
ultrasound scanner, Nerve was visualised
in the suprascapular notch,
10-15 mLs of 0.5% Bupivacaine
Methods
Jan 2010 – Sep 2010 24 consecutive patients Inclusion criteria:
- Primary frozen shoulder - Persistent postoperative stiffness failed physiotherapy and oral analgesia
Three patients were excluded:- 2 were lost to follow-up- 1 underwent surgery within 2 weeks
Methods
Numerical analogue pain score (NAPS, 0-10) at:Pre-block, 20min, 2-3 days, 2 weeks and 8 weeks
Oxford Shoulder Score (OSS) at pre-block and 8 weeks post-block.
Complications
Results
11 (55%) females 12 right, 9 left Mean age 55 ± 11 years 9 post-operative stiffness
8 primary frozen shoulders2 others
Results
19 (90%) patients had significant improvement of their NAPS and OSS,2 (10%) had no significant improvement
Mean post-block NAPS were significantly lower than pre-block NAPS at all points (p<0.0001)
Mean OSS was significantly improved at 8 weeks (p=0.0005)
NAPS
OSS
Results
No complications recorded
Better response in the persistent postoperative stiffness group (not statistically significant)
Conclusion
SSNB is a simple, quick and safe technique that can achieve rapid, albeit temporary, relief of shoulder pain
Allows time for contemplating other interventions (physiotherapy, surgery)
Further research - compare to other types of injections
Questions?