Brennan C, Slevin Z, Savaridas T
Department of Trauma and Orthopaedic Surgery, NHS Forth Valley, Stirling, UK.
West of Scotland Deanery, Scotland, UK.
Shoulder Elbow. 2024 Jul;16(3):336-341. doi: 10.1177/17585732231164623. Epub 2023 Mar 23.
The suprascapular nerve is an ideal target for nerve blockade to alleviate shoulder pain given its widespread innervation to the shoulder girdle. To widen availability of this treatment, we investigate whether an anatomical landmark technique can be adopted by novice injectors to provide efficacious blockade.
Five injectors were recruited with varying experience. 10 shoulders of Thiel embalmed cadavers were injected with blue dye. Written instructions and an illustration of the Dangoisse landmark technique were provided prior to injection. Cadavers were dissected and the presence or absence of dye staining reported by three observers and a consensus agreement reached.
Dissection demonstrated diffuse staining in the suprascapular fossa. 90% of shoulders had adequate staining of the suprascapular nerve directly, or distal branches, which would provide adequate anaesthesia. Inter-observer agreement was good (k = 0.73) for staining at the supraspinous fossa and excellent (k = 0.87) for staining distally. The technique was performed by novice injectors with a good success rate.
This technique is reproducible by a range of clinicians to effectively provide anaesthesia of the SScN. Within a resource strained healthcare environment greater uptake of this technique is likely to be of benefit to a wider group of patients.
肩胛上神经是缓解肩部疼痛的神经阻滞理想靶点,因为它广泛支配肩胛带。为扩大这种治疗方法的可及性,我们研究新手注射者是否可以采用一种解剖标志技术来进行有效的阻滞。
招募了5名经验各异的注射者。向10具经蒂尔氏防腐处理尸体的肩部注射蓝色染料。在注射前提供了丹戈伊斯标志技术的书面说明和图示。对尸体进行解剖,由三名观察者报告染料染色情况,并达成共识。
解剖显示肩胛上窝有弥漫性染色。90%的肩部肩胛上神经直接或其远端分支有足够的染色,这将提供足够的麻醉效果。观察者间在肩胛上窝染色方面的一致性良好(k = 0.73),在远端染色方面一致性极佳(k = 0.87)。新手注射者实施该技术的成功率较高。
一系列临床医生均可重复使用该技术,以有效实现肩胛上神经干的麻醉。在资源紧张的医疗环境中,更多地采用该技术可能会使更多患者受益。