The suprascapular nerve blockade is useful in patients as a therapeutic procedure for pain in the shoulder region. This block is used as an adjuvant to physical therapy in patients with limited range of motion secondary to arthritic shoulder pain, shoulder-hand syndrome, and shoulder pain.
After informed consent is obtained, the patient is placed in the sitting position. The spine of the scapula is divided by a line formed by the bisection of the scapular angle. The upper outer quadrant formed from the spine of the scapula and the vertical line bisecting the angle of the scapula is marked, and a point is marked 2 cm anteriorly along this line for needle insertion. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 3-in. (8-cm), 23- to 25-gauge needle is inserted perpendicular to the skin and, using a nerve stimulator, advanced until needle placement is confirmed by movements of the supraspinatus and infraspinatus muscles. After negative aspiration, 5 mL of local anesthetic is injected (Fig. 67-5).
FIGURE 67-5. Suprascapular nerve block. Approach for suprascapular nerve injection and neural blockade.
The suprascapular nerve is a branch from the trunk of the brachial plexus, which enters the scapular region through the suprascapular notch on the cephalic border of the scapula. Confirmation of the block is determined when abduction of the arm is diminished over the first 15 degrees. If a nerve stimulator is not available, the same technique is used, with the needle advanced to the dorsal surface of the scapula. The needle is then walked along the edge of the scapula to the suprascapular notch.
Intraneural injection may result in nerve damage. Severe pain on injection suggests the possibility of an intraneural injection, and the needle should be repositioned immediately. Hematoma and intravascular injection are possible, owing to the close proximity of the suprascapular vessels. Pneumothorax is possible if the needle is advanced beyond the scapula and into the pleura. Most pneumothoraces can be treated easily with administration of supplemental oxygen and close observation and, when necessary, needle aspiration of air. Only those pneumothoraces that result in significant dyspnea or those under tension require chest tube thoracotomy and vacuum drainage.