Schoenherr Jay W., Flynn David N., Doyal Alexander
University of North Carolina
University of North Carolina at Chapel Hill
Blockade of the suprascapular nerve is an effective method for providing anesthesia and analgesia for the shoulder. The suprascapular nerve contributes to the sensory innervation of the acromioclavicular and glenohumeral joints, as well as motor innervation of the supraspinatus and infraspinatus muscles. The suprascapular nerve can be specifically targeted to provide shoulder analgesia while potentially sparing blockade of the phrenic nerve. This procedure is usually performed as an alternative to the interscalene brachial plexus block, which routinely causes hemi-diaphragmatic paralysis via phrenic nerve blockade. There are two well-described techniques for blocking the suprascapular nerve. The first is the landmark-based posterior approach, first reported in 1941 by Wertheim and Rovenstein to treat severe chronic shoulder pain. Subsequently, nerve stimulation and ultrasound guidance have been used to identify and block the suprascapular nerve more reliably. However, the posterior approach remains challenging because of the small diameter of the nerve and its anatomic location within the suprascapular fossa, beneath the trapezius and supraspinatus muscles. In 2012, Andreas Siegenthaler and colleagues described a novel, ultrasound-guided anterior approach to the suprascapular nerve block. This review will address the indications, sonoanatomy, technique, and potential complications for posterior and anterior approaches to blocking the suprascapular nerve.
肩胛上神经阻滞是为肩部提供麻醉和镇痛的有效方法。肩胛上神经负责肩锁关节和盂肱关节的感觉神经支配，以及冈上肌和冈下肌的运动神经支配。肩胛上神经可以被特异性地靶向，以提供肩部镇痛，同时有可能避免膈神经阻滞。该操作通常作为肌间沟臂丛神经阻滞的替代方法，后者通常会因膈神经阻滞而导致半膈肌麻痹。有两种广为人知的肩胛上神经阻滞技术。第一种是基于体表标志的后路法，1941年由韦特海姆和罗文斯坦首次报道，用于治疗严重的慢性肩部疼痛。随后，神经刺激和超声引导被用于更可靠地识别和阻滞肩胛上神经。然而，后路法仍然具有挑战性，因为神经直径较小，且其解剖位置位于肩胛上窝内，在斜方肌和冈上肌下方。2012年，安德烈亚斯·西根塔勒及其同事描述了一种新型的、超声引导的肩胛上神经阻滞前路法。本综述将探讨肩胛上神经阻滞后路法和前路法的适应症、超声解剖、技术及潜在并发症。
