Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France; Anatomy Laboratory, Rangueil University Hospital, Toulouse, France.
Department of Orthopaedic Surgery, Centre Hospitalier Universitaire de Reims, Reims, France.
J Shoulder Elbow Surg. 2019 Jul;28(7):1291-1297. doi: 10.1016/j.jse.2018.11.073. Epub 2019 Mar 4.
A bone landmark-based approach (LBA) to the distal suprascapular nerve (dSSN) block is an attractive "low-tech" method available to physicians with no advanced training in regional anesthesia or ultrasound guidance. The primary aim of this study was to validate the feasibility of an LBA to blockade of the dSSN by orthopedic surgeons using anatomic analysis. The secondary aim was to describe the anatomic features of the sensory branches of the dSSN.
An LBA was performed in 15 cadaver shoulders by an orthopedic resident. Then, 10 mL of methylene blue-infused 0.75% ropivacaine was injected around the dSSN; 2.5mL of red latex solution was also injected to identify the position of the needle tip. The division and distribution of the sensory branches that originate from the suprascapular nerve were described.
The median distance between the dSSN and the site of injection was 1.5 cm (0-4.5 cm). The most common injection site was at the proximal third of the scapular neck (n = 8). Fifteen dSSNs were stained proximal to the origin of the most proximal sensory branch. All 15 dSSNs gave off 3 sensory branches that innervated the posterior glenohumeral capsule, the subacromial bursa, and the coracoclavicular and acromioclavicular ligaments.
An LBA for anesthetic blockade of the dSSN by an orthopedic surgeon is a simple, reliable, and accurate method. Injection close to the suprascapular notch is recommended to involve the dSSN proximally and its 3 sensory branches.
基于骨标志的方法（LBA）是一种有吸引力的“低技术”方法，适用于没有接受过区域麻醉或超声引导高级培训的医生，用于阻滞远端肩胛上神经（dSSN）。本研究的主要目的是通过解剖学分析验证骨科医生使用 LBA 阻滞 dSSN 的可行性。次要目的是描述 dSSN 的感觉支的解剖特征。
一名骨科住院医师在 15 个尸体肩部进行了 LBA。然后，在 dSSN 周围注射 10 毫升亚甲蓝浸润的 0.75%罗哌卡因；还注射了 2.5 毫升红色乳胶溶液以确定针尖的位置。描述了发自肩胛上神经的感觉支的分支和分布。
dSSN 与注射部位之间的中位数距离为 1.5cm（0-4.5cm）。最常见的注射部位是肩胛颈的近端三分之一（n=8）。15 个 dSSN 在最近端感觉支的起点近端被染色。所有 15 个 dSSN 发出 3 条感觉支，支配后盂肱关节囊、肩峰下囊以及喙锁和肩锁韧带。
骨科医生使用 LBA 进行 dSSN 的麻醉阻滞是一种简单、可靠且准确的方法。建议在肩胛上切迹附近注射，以涉及 dSSN 近端及其 3 条感觉支。
