Feigl Georg Christoph, Anderhuber Friedrich, Dorn Christian, Pipam Wolfgang, Rosmarin Walter, Likar Rudolph
Department of Anatomy, Medical University Graz, Graz, Austria.
Reg Anesth Pain Med. 2007 Nov-Dec;32(6):488-94. doi: 10.1016/j.rapm.2007.06.394.
This paper presents an evaluation of a modified lateral suprascapular nerve block with easy orientation, low risk of displacement of the needle, and with an assessment of 2 different volumes to propose an ideal volume for a successful block.
Both shoulders of 34 cadavers were investigated. Insertion point of the needle was determined in the angle of the lateral end of the clavicle, acromion, and the spine of the scapula. The needle was directed toward the medial, dorsal, and caudad direction. Ten mL of diluted contrast agent for computerized tomography was injected in the 34 right sides (group A) and 5 mL in the 34 left sides (group B). Immediately after injection, all shoulders were investigated by computerized tomography scans and 3-dimensional reconstruction to document the constrast dissemination. Five sides of each group were injected with colored contrast and dissected after computerized tomography investigation.
Group A showed a distribution to the entire supraspinous fossa in all cases and the contrast was pressed out of the suprascapular notch in 4 cases with a maximal extension into the axillary fossa in 3 cases. In group B, the supraspinous fossa was filled in 24 cases, with a maximal extension to the axillary fossa in 2 cases. In 9 cases, the contrast agent stayed in the lateral half of the supraspinous fossa. In 1 case we had a medial spread only which still surrounded the suprascapular notch, in another case a superficial spread with misplacement of the needle.
Based on this cadaver study, the lateral modified approach appears to be a safe technique for a suprascapular nerve block, which might be preferred as a single shot technique. A 5 mL volume appears sufficient to fill the supraspinous fossa and to reach the suprascapular nerve, which branches in this anatomical compartment.
本文介绍了一种改良的肩胛上神经外侧阻滞方法，该方法定位容易，针移位风险低，并评估了两种不同的注射量，以提出成功阻滞的理想注射量。
对34具尸体的双侧肩部进行研究。确定针的进针点位于锁骨外侧端、肩峰和肩胛冈形成的夹角处。针朝内侧、背侧和尾侧方向进针。在34例右侧（A组）注射10 mL稀释的计算机断层扫描造影剂，在34例左侧（B组）注射5 mL。注射后立即对所有肩部进行计算机断层扫描和三维重建，以记录造影剂的扩散情况。每组选取5侧注射彩色造影剂，在计算机断层扫描检查后进行解剖。
A组所有病例造影剂均分布至整个冈上窝，4例造影剂从肩胛上切迹挤出，3例造影剂最大延伸至腋窝。B组24例冈上窝被填满，2例造影剂最大延伸至腋窝。9例造影剂停留在冈上窝外侧半。1例造影剂仅向内侧扩散，但仍环绕肩胛上切迹，另1例造影剂呈浅表扩散且针位置不当。
基于本尸体研究，改良外侧入路似乎是一种安全的肩胛上神经阻滞技术，可作为单次注射技术优先选用。5 mL的注射量似乎足以填满冈上窝并到达在该解剖区域分支的肩胛上神经。
