Royal Devon and Exeter Foundation Trust, UK.
University of Exeter Medical School, UK.
Ann R Coll Surg Engl. 2023 Sep;105(7):589-598. doi: 10.1308/rcsann.2022.0026. Epub 2022 Aug 17.
Suprascapular nerve blockade (SSNB) through injection (SSNBi) and/or pulsed radiofrequency (PRF) provide options for the management of painful shoulder pathology. Multiple techniques for delivery of SSNB are described but no consensus on optimal symptom control is available. This systematic review and meta-analysis aims to assess patient-focussed outcomes in SSNB and explore the impact of variation in the technical application of this treatment modality.
MEDLINE, Embase and CINAHL were searched for case series, cohort studies and randomised control trials published from database inception until 28 January 2021. Articles reporting use of SSNBi or PRF for treatment of shoulder pain with a minimum 3 months follow-up were included. Patient-reported outcome measures (PROMs) were extracted and the pooled standardised mean difference (SMD), weighted by study size, was reported. Quality of methodology was assessed using Wylde's nonsummative four-point system.
Of 758 references, 18 studies were included, totalling 704 SSNB. Average pain improvement at 3 months was 52.3%, with meta-analysis demonstrating a SMD of 2.37. Whereas SSNBi combined with PRF shows the greatest SMD of 2.75, this did not differ significantly from SSNBi or PRF when used as monotherapy. Location of treatment and the guidance technique used did not influence outcome.
SSNBi and PRF provide safe and effective treatment for shoulder pain, as judged by PROMs. This may be of particular value in aging or comorbid patients and with surgical restrictions during the COVID-19 pandemic. Regardless of technique, patients experience a marked improvement in pain that is maintained beyond 3 months.
肩胛上神经阻滞（SSNB）通过注射（SSNBi）和/或脉冲射频（PRF）为治疗肩部疼痛性病变提供了选择。有多种方法可用于实施 SSNB，但目前尚未达成关于最佳症状控制的共识。本系统评价和荟萃分析旨在评估 SSNB 的患者重点结局，并探讨该治疗方式技术应用差异的影响。
从数据库建立开始至 2021 年 1 月 28 日，检索 MEDLINE、Embase 和 CINAHL 中关于 SSNBi 或 PRF 治疗肩部疼痛且随访时间至少 3 个月的病例系列、队列研究和随机对照试验。纳入报告使用 SSNBi 或 PRF 治疗肩部疼痛且至少有 3 个月随访的文章。提取患者报告的结局测量（PROM），并按研究规模加权报告标准化均数差（SMD）。使用 Wylde 非总结性四点系统评估方法学质量。
在 758 篇参考文献中，有 18 项研究被纳入，共纳入 704 例 SSNB。3 个月时疼痛平均改善率为 52.3%，荟萃分析显示 SMD 为 2.37。虽然 SSNBi 联合 PRF 的 SMD 最大（2.75），但与 SSNBi 或 PRF 单用时相比，差异无统计学意义。治疗部位和使用的引导技术对结局无影响。
SSNBi 和 PRF 为肩部疼痛提供了安全有效的治疗，这可从 PROM 中得到判断。这在老龄化或合并症患者以及在 COVID-19 大流行期间手术受限的情况下可能特别有价值。无论采用何种技术，患者的疼痛都会显著改善，且这种改善可维持 3 个月以上。
