• Pierre Laumonerie, Laurent Blasco, Meagan E Tibbo, Kerezoudis Panagiotis, Olivier Fernandes, Frederic Lauwers, Nicolas Bonnevialle, Pierre Mansat, and Xavier Ohl.
• Anatomy Laboratory, Paul Sabatier-Toulouse III University, Toulouse, France; Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France. Electronic address: laumonerie.pierre@hotmail.fr.
• Arthroscopy. 2019 Aug 1; 35 (8): 2274-2281.

PurposeTo compare the accuracy of distal suprascapular nerve (dSSN) blockade performed with the use of ultrasound-guided regional anesthesia (USRA) versus with a landmark-based approach (LBA). A secondary aim was to describe the anatomic features of the sensory branches of the dSSN.MethodsUSRA and LBA were performed in 15 shoulders each from 15 cadavers (total of 30 shoulders). Then, 10 mL of methylene blue‒infused ropivacaine 0.75% was injected into the dSSN. Simultaneously, 2.5 mL of red latex solution was injected to identify the position of the needle tip. The division and distribution of the sensory branches originating from the SSN were described.ResultsThe tip of the needle was identified at 1.3 cm (range, 0-5.2 cm) and 1.5 cm (range, 0-4.5 cm) with USRA and the LBA, respectively (P = .90). Staining diffused past the origin of the most proximal sensory branch in 27 cases. The most proximal sensory branch arose 2.5 cm from the suprascapular notch. Among the 3 failures that occurred in the USRA group, the sensory branches also failed to be marked. All 30 dSSNs gave off 3 sensory branches, which innervated the posterior glenohumeral capsule, the subacromial bursa, and the coracoclavicular and acromioclavicular ligaments.ConclusionsAn LBA is as reliable and accurate as US guidance for anesthetic blockade of the dSSN. Marking of the suprascapular nerve must be proximal to the suprascapular notch to involve the 3 sensory branches in the anesthetic blockade.Clinical RelevanceThe present study demonstrates that a landmark-based approach to anesthetic blockade of the distal suprascapular nerve is accurate and can be performed by orthopaedic surgeons lacking experience in ultrasound-guided anesthetic techniques.Copyright © 2019 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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