Surgery Book

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Ultrasound-Guided Suprascapular Nerve Block

Aka: Ultrasound-Guided Suprascapular Nerve Block, Suprascapular Nerve Block, Scapular Notch Block
  1. Indications
    1. Anesthesia to medial Shoulder (lateral Shoulder would require axillary Nerve Block)
  2. Anatomy
    1. Suprascapular Nerve originates from C4-6 nerve roots and passes posteriorly through the Scapular notch
      1. Innervates supraspinatus muscle and infraspinatus muscle
      2. Innervates glenohumeral joint and acromioclavicular joint
      3. Innervates coracohumeral ligament
      4. Innervates Scapula and subacromial bursa
    2. Risk of adverse effects on nearby structures
      1. Suprascapular artery (passes through notch with the nerve)
  3. Preparation
    1. Identify and mark landmarks
      1. Scapular Spine
    2. Skin preparation (e.g. Chlorhexidine)
    3. Drape region
    4. Sterile covering over Ultrasound high frequency linear probe (sterile gel inside and outside)
    5. Medication
      1. Confirm maximum dose for Ropivacaine (or Bupivacaine ) to prevent LAST Reaction
      2. Ropivacaine 0.5% (preferred over Bupivacaine 0.25% to 0.5%) 10-15 ml
      3. Syringe 20 ml
      4. Needle 22 gauge, 4 inch (10 cm)
  4. Technique
    1. Images
      1. suprascapularBlockUs.jpg
    2. Ultrasound in transverse plane, directed inferiorly (toward feet), just posterior to Scapular spine
      1. High frequency linear probe
    3. Injection Plane
      1. Inject from medial to lateral
      2. Target is within the Scapular notch in the vicinity of the suprascapular nerve
        1. Avoid injecting into the suprascapular nerve or suprascapular artery
  5. Adverse Effects
    1. LAST Reaction (as with any Nerve Block)
  6. References
    1. Reardon and Martel (2020) Regional Anesthesia for Acute Care Conference, attended 12/11/2020
      1. https://stabroom.com/
    2. Combined Suprascapular and Axillary (Circumflex) Nerve Block, NYSORA, accessed 12/21/2020
      1. https://www.nysora.com/newsletters/jnysora/combined-suprascapular-and-axillary-circumflex-nerve-block-the-shoulder-block/
    3. Suprascapular Nerve Block, USRA, accessed 12/21/2020
      1. http://www.usra.ca/pain-medicine/specific-blocks/peripheral-nerves/suprascapular.php
    4. Suprascapular Nerve Block, Physio-Pedia, accessed 12/21/2020
      1. https://www.physio-pedia.com/Suprascapular_Nerve_Block
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