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?