Sultan J, Wilson J, Glover J, Goodyear E, Narendran U, Roy B. Trafford General Hospital

Introduction  70% of pain sensation around the shoulder is transmitted via the suprascapular nerve  Suprascapular nerve block (SSNB) has been previously described as a method of controlling pain from the shoulder (rheumatology clinics)  Bedside ultrasound-guided nerve blocks

Aim  To assess the efficacy of ultrasound- guided suprascapular nerve block for pain control in a group of patients with persistent shoulder pain and reduced function.

Methods  Two experienced anaesthetists;  High-resolution ultrasound scanner,  Nerve was visualised in the suprascapular notch,  mLs of 0.5% Bupivacaine

Methods  Jan 2010 – Sep 2010  24 consecutive patients  Inclusion criteria: - Primary frozen shoulder - Persistent postoperative stiffness failed physiotherapy and oral analgesia  Three patients were excluded: - 2 were lost to follow-up - 1 underwent surgery within 2 weeks

Methods  Numerical analogue pain score (NAPS, 0-10) at: Pre-block, 20min, 2-3 days, 2 weeks and 8 weeks  Oxford Shoulder Score (OSS) at pre-block and 8 weeks post-block.  Complications

Results  11 (55%) females  12 right, 9 left  Mean age 55 ± 11 years  9 post-operative stiffness 8 primary frozen shoulders 2 others

Results  19 (90%) patients had significant improvement of their NAPS and OSS, 2 (10%) had no significant improvement  Mean post-block NAPS were significantly lower than pre-block NAPS at all points (p<0.0001)  Mean OSS was significantly improved at 8 weeks (p=0.0005)

NAPS

OSS

Results  No complications recorded  Better response in the persistent postoperative stiffness group (not statistically significant)

Conclusion  SSNB is a simple, quick and safe technique that can achieve rapid, albeit temporary, relief of shoulder pain  Allows time for contemplating other interventions (physiotherapy, surgery)  Further research - compare to other types of injections  Questions?