Diwan Sandeep, Sathe Deepika, Sabnis Anjali, Mane Prakash, Gupta Anju
Department of Anesthesiology, Sancheti Hospital, Pune, India.
Department of Anesthesia, MGM Hospital, Navi Mumbai, India.
Anesth Pain Med (Seoul). 2025 Apr;20(2):175-182. doi: 10.17085/apm.24142. Epub 2025 Apr 30.
Anterior suprascapular nerve block is widely used for postoperative shoulder pain management. Although cadaveric studies show the spread and smudging of the phrenic nerve, our cadaveric injection investigation was conducted to investigate the pathway of diffusion of the dye toward the phrenic nerve from a more distal injection at the suprascapular nerve.
We injected 5 ml of 0.1% methylene blue dye into the proximal portion of the suprascapular nerve (infra-omohyoid in the posterior triangle) in 12 neck specimens from six cadavers. Following meticulous dissection, we assessed the spread of the dye along the brachial plexus to the nerve roots and traced the phrenic nerve for staining.
The phrenic nerve was stained in 41.7% of the cases, the inferior trunk of the brachial plexus was unstained in all cases (100%), and the posterior division and suprascapular nerve were stained in all cases (100%). The nerves to the subclavius, dorsal aspect of the superior trunk, and C5 and C6 roots were stained in all cases. Anterior division of the superior trunk was observed in 75% of the specimens. The dye-spread pathway along the brachial plexus was dorsal, sparing the ventral aspect.
Our study demonstrated that the dye-spread pathway from the suprascapular nerve at the infra-omohyoid level to the phrenic nerve is dorsal to the brachial plexus.
肩胛上神经阻滞广泛应用于术后肩部疼痛管理。尽管尸体研究显示了膈神经的扩散和模糊，但我们进行尸体注射研究，以探究染料从肩胛上神经更远处注射向膈神经的扩散途径。
我们在来自6具尸体的12个颈部标本中，将5毫升0.1%的亚甲蓝染料注入肩胛上神经近端（后三角内肩胛舌骨肌下方）。经过细致解剖后，我们评估染料沿臂丛神经向神经根的扩散情况，并追踪膈神经是否被染色。
41.7%的病例中膈神经被染色，所有病例（100%）臂丛神经下干均未被染色，所有病例（100%）后支和肩胛上神经均被染色。所有病例中锁骨下肌、上干背侧以及C5和C6神经根的神经均被染色。75%的标本中观察到上干前支。染料沿臂丛神经的扩散途径为背侧，腹侧未受影响。
我们的研究表明，染料从肩胛舌骨肌下方水平的肩胛上神经向膈神经的扩散途径位于臂丛神经的背侧。
