• Pierre Laumonerie, Laurent Blasco, Meagan E Tibbo, Yohann Renard, Panagiotis Kerezoudis, Patrick Chaynes, Nicolas Bonnevialle, and Pierre Mansat.
• Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France; Anatomy Laboratory, Rangueil University Hospital, Toulouse, France. Electronic address: laumonerie.pierre@hotmail.fr.
• J Shoulder Elbow Surg. 2019 Jul 1; 28 (7): 1291-1297.

BackgroundA bone landmark-based approach (LBA) to the distal suprascapular nerve (dSSN) block is an attractive "low-tech" method available to physicians with no advanced training in regional anesthesia or ultrasound guidance. The primary aim of this study was to validate the feasibility of an LBA to blockade of the dSSN by orthopedic surgeons using anatomic analysis. The secondary aim was to describe the anatomic features of the sensory branches of the dSSN.Materials And MethodsAn LBA was performed in 15 cadaver shoulders by an orthopedic resident. Then, 10 mL of methylene blue-infused 0.75% ropivacaine was injected around the dSSN; 2.5mL of red latex solution was also injected to identify the position of the needle tip. The division and distribution of the sensory branches that originate from the suprascapular nerve were described.ResultsThe median distance between the dSSN and the site of injection was 1.5 cm (0-4.5 cm). The most common injection site was at the proximal third of the scapular neck (n = 8). Fifteen dSSNs were stained proximal to the origin of the most proximal sensory branch. All 15 dSSNs gave off 3 sensory branches that innervated the posterior glenohumeral capsule, the subacromial bursa, and the coracoclavicular and acromioclavicular ligaments.ConclusionsAn LBA for anesthetic blockade of the dSSN by an orthopedic surgeon is a simple, reliable, and accurate method. Injection close to the suprascapular notch is recommended to involve the dSSN proximally and its 3 sensory branches.Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

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