Ultrasound-guided suprascapular nerve block technique.
BACKGROUND
In this article, we describe a case report of using real-time, high-resolution ultrasound guidance to facilitate blockade of the suprascapular nerve. We describe a case report and technique for using a portable ultrasound scanner (38 mm broadband (13-6 MHz) linear array transducer (SonoSite Micromaxx SonoSite, Inc. 21919 30th Drive SE Bothwell W. A..)) to guide suprascapular nerve block.


METHODS
A 44-year old male patient presented with severe, painful osteoarthritis with adhesive capsulitis of his right shoulder. The ultrasound transducer in a transverse orientation was placed over the scapular spine. Moving the transducer cephalad the suprascapular fossa was identified. While imaging the supraspinatus muscle and the bony fossa underneath, the ultrasound transducer was moved laterally (maintaining a transverse transducer orientation) to locate the suprascapular notch. The suprascapular nerve was seen as a round hyperechoic structure at 4 cm depth beneath the transverse scapular ligament in the scapular notch. The nerve had an approximate diameter of 200 mm. Real-time imaging was used to direct injection in the scapular notch. Ultrasound scanning confirmed local anesthetic spread.


RESULTS
The patient's pain intensity decreased. Shoulder movement and function improved. These improvements were maintained at 12 weeks.


CONCLUSIONS
Ultrasound guidance does not expose patients and personnel to radiation. It is also less expensive than other imaging modalities. This technique has applications in both acute and chronic pain management.
Harmon
Dominic
D
Department of Anesthesia and Pain Medicine, Mid-Western Regional Hospital, Dooradoyle, Limerick, Ireland. dominicharmon@hotmail.com
Hearty
Conor
C
D000328:Adult; D000772:Anesthesia, Local / Q000295:instrumentation / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D018771:Arthralgia / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D001917:Brachial Plexus / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D000077554:Levobupivacaine; D008022:Ligaments / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D009407:Nerve Block / Q000295:instrumentation / Q000379:methods*; D010003:Osteoarthritis / Q000150:complications / Q000503:physiopathology; D010525:Peripheral Nerves / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000187:drug effects; D012540:Scapula / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D012785:Shoulder Joint / Q000294:innervation / Q000503:physiopathology; D020069:Shoulder Pain / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D013995:Time; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage; D014463:Ultrasonography / Q000295:instrumentation / Q000379:methods*
D000779:Anesthetics, Local; D014221:Triamcinolone; D000077554:Levobupivacaine; D002045:Bupivacaine