Anatomy Laboratory, Paul Sabatier-Toulouse III University, Toulouse, France; Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France.
Department of Orthopaedic Surgery, Centre Hospitalier Universitaire de Reims, Reims, France.
Arthroscopy. 2019 Aug;35(8):2274-2281. doi: 10.1016/j.arthro.2019.02.050. Epub 2019 Jul 23.
To compare the accuracy of distal suprascapular nerve (dSSN) blockade performed with the use of ultrasound-guided regional anesthesia (USRA) versus with a landmark-based approach (LBA). A secondary aim was to describe the anatomic features of the sensory branches of the dSSN.
USRA and LBA were performed in 15 shoulders each from 15 cadavers (total of 30 shoulders). Then, 10 mL of methylene blue‒infused ropivacaine 0.75% was injected into the dSSN. Simultaneously, 2.5 mL of red latex solution was injected to identify the position of the needle tip. The division and distribution of the sensory branches originating from the SSN were described.
The tip of the needle was identified at 1.3 cm (range, 0-5.2 cm) and 1.5 cm (range, 0-4.5 cm) with USRA and the LBA, respectively (P = .90). Staining diffused past the origin of the most proximal sensory branch in 27 cases. The most proximal sensory branch arose 2.5 cm from the suprascapular notch. Among the 3 failures that occurred in the USRA group, the sensory branches also failed to be marked. All 30 dSSNs gave off 3 sensory branches, which innervated the posterior glenohumeral capsule, the subacromial bursa, and the coracoclavicular and acromioclavicular ligaments.
An LBA is as reliable and accurate as US guidance for anesthetic blockade of the dSSN. Marking of the suprascapular nerve must be proximal to the suprascapular notch to involve the 3 sensory branches in the anesthetic blockade.
The present study demonstrates that a landmark-based approach to anesthetic blockade of the distal suprascapular nerve is accurate and can be performed by orthopaedic surgeons lacking experience in ultrasound-guided anesthetic techniques.
比较超声引导区域麻醉（USRA）与基于体表标志的方法（LBA）行远端肩胛上神经（dSSN）阻滞的准确性。次要目的是描述 dSSN 感觉支的解剖学特征。
在 15 具尸体的 30 个肩关节中，每个肩关节分别进行 USRA 和 LBA，然后将 10ml 含亚甲蓝的 0.75%罗哌卡因注入 dSSN。同时，注入 2.5ml 红色乳胶溶液以确定针尖的位置。描述源自 SSN 的感觉支的分支和分布。
USRA 和 LBA 时，针尖分别位于 1.3cm（范围，0-5.2cm）和 1.5cm（范围，0-4.5cm）（P=.90）。在 27 例中，染色扩散超过了最近端感觉支的起源。最近端的感觉支发自肩胛上切迹 2.5cm 处。在 USRA 组的 3 次失败中，感觉支也未能标记。30 个 dSSN 均发出 3 个感觉支，支配后盂肱关节囊、肩峰下囊和喙锁及肩锁韧带。
LBA 与 US 引导 dSSN 麻醉阻滞一样可靠和准确。标记肩胛上神经必须在肩胛上切迹近端，以将 3 个感觉支纳入麻醉阻滞中。
本研究表明，基于体表标志的方法对 dSSN 麻醉阻滞是准确的，并且可以由缺乏超声引导麻醉技术经验的骨科医生来进行。
