A preliminary study of a novel technique of suprascapular nerve block in treating chronic shoulder pain

A, Deepak K. Feasibility of Ultrasound-Guided Suprascapular Nerve Block in Improving Shoulder Motion and Pain Post-Surgery in Breast Cancer Survivors: A Randomized Control Trial

Patients with locally advanced breast cancer post-mastectomy complain of shoulder pain and restricted shoulder movement. The role of suprascapular nerve block (SSNB) in such patients needs to be explained as it may help in improving their quality of life along with pain relief. This study aims to evaluate the effect of ultrasound-guided suprascapular nerve block (SSNB) in improving shoulder motion and pain following surgery and compare its effect with exercise group. This study is a randomized controlled trial. Forty-eight patients were enrolled in the study who were referred from the endocrine surgery department, and they were randomized into two groups. Group A underwent ultrasound-guided (USG-guided) SSNB and Group B underwent an exercise program only. Each group had 24 patients who complained of pain and restricted shoulder range of motion (ROM). The outcome measures were assessed using the Mann-Whitney test for visual analog score and unpaired t-test for shoulder ROM and Quick Disabilities of Arm, Shoulder, and Hand (Q-DASH) questionnaire score. All patients (n = 48) had modified radical mastectomy. The mean age was 44 ± 9.44 years and all were female gender. The improvement was noted in both the groups, but in intergroup comparison, Group A patients had significant improvement in VAS, Q-DASH score, shoulder flexion, and abduction immediately and at the 4th week follow-up (p = 0.001). No adverse effect was reported. A small sample size and no blinding reduce the strength of the study. USG-guided SSNB in post-mastectomy patients is proven to be an effective, safe, and economically accepted treatment for low-resource countries like India.

A systematic review of the methods and drugs used for performing suprascapular nerve block injections for the non-surgical management of chronic shoulder pain

Suprascapular nerve block (SSNB) injections are growing in popularity as a treatment option for people with chronic shoulder pain. The optimal method of injection and aftercare is unknown. This review describes the current methods and drugs used for performing SSNB injections in the non-surgical management of adults with chronic shoulder pain in order to inform future research in this area. Systematic searches of CINAHL, MEDLINE (OVID), AMED, Embase databases and the Cochrane Library were undertaken from inception to June 2020. Data on the method and drugs used for injection and aftercare were extracted and summarised for areas of commonality and discrepancy. We included 53 studies in this review. In total, eight different injection methods were reported within the included studies. Indirect surface land-marked methods were the most common method reported in 21 studies. Direct surface land-marked methods were reported in 12 studies. Ultrasound-guided methods used alone were reported in 16 studies. Both fluoroscopy and computed tomography methods used alone were reported in one study each. Electromyography was used in combination with other injection methods in nine studies. Wide variation in the composition of the injectate was observed between studies. Local anaesthetic was used within injectate preparations in all studies. Local anaesthetic used alone was reported in 20 studies, combined with steroid in 29 studies and combined with various other components in 5 studies. Physiotherapy following injection was reported in 26 studies. Reported details of physiotherapy varied considerably. This review identified substantial variation in the methods and drugs used to perform SSNB injection in clinical trials. Current literature demonstrates a wide range of methods used for SSNB injection administration. Consensus research defining standardised practice for SSNB injection is now needed to guide future clinical practice and research.