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Correspondence  |   August 2018
Postoperative Analgesia after Shoulder Surgery
Author Notes
  • University Hospital of North Norway and the Arctic University of Norway, Tromsø, Norway (L.M.Y.). lars.marius.ytrebo@unn.no
  • (Accepted for publication May 1, 2018.)
    (Accepted for publication May 1, 2018.)×
Article Information
Correspondence
Correspondence   |   August 2018
Postoperative Analgesia after Shoulder Surgery
Anesthesiology 8 2018, Vol.129, 379-380. doi:10.1097/ALN.0000000000002276
Anesthesiology 8 2018, Vol.129, 379-380. doi:10.1097/ALN.0000000000002276
To the Editor:
Dr. Hussain et al. have recently published a review and meta-analysis on suprascapular and interscalene nerve blocks for shoulder surgery.1  The primary objective of the study was to compare postoperative analgesic efficacy between the interscalene nerve block and the suprascapular nerve block. We would like to comment on this very interesting research question.
It is well accepted that the shoulder joint is mainly innervated by the suprascapular and the axillary nerve, but receives contributions from the subscapular and the lateral pectoral nerves.2–4  Two nerves provide the cutaneous innervation of the shoulder: the supraclavicular and the axillary nerves. The first of these is not derived from the brachial plexus, but arises from the superficial cervical plexus. In theory, to achieve optimal postoperative analgesia, all sensory nerves should be blocked.
Interscalene nerve block has been the gold standard for shoulder surgery, as it covers all relevant nerves except the supraclavicular nerves. We believe that suprascapular nerve block should, particularly for patients receiving total shoulder arthroplasty, be supplemented with additional blocks. Leaving one or more of the pertinent nerves without any local anesthetic may cause unnecessary postoperative pain after shoulder surgery.
Competing Interests
The authors declare no competing interests.
Dario Musso, M.D., Øivind Klaastad, M.D., Ph.D., Lars M. Ytrebø, M.D., Ph.D. University Hospital of North Norway and the Arctic University of Norway, Tromsø, Norway (L.M.Y.). lars.marius.ytrebo@unn.no
References
Hussain, N, Goldar, G, Ragina, N, Banfield, L, Laffey, JG, Abdallah, FW Suprascapular and interscalene nerve block for shoulder surgery: A systematic review and meta-analysis. Anesthesiology 2017; 127:998–1013 [Article] [PubMed]
Aszmann, OC, Dellon, AL, Birely, BT, McFarland, EG Innervation of the human shoulder joint and its implications for surgery. Clin Orthop Relat Res 1996;330:202–7 [Article]
Gardner, E The innervation of the shoulder joint. Anat Rec 1948; 102:1–18 [Article] [PubMed]
Tran, DQ, Elgueta, MF, Aliste, J, Finlayson, RJ Diaphragm-sparing nerve blocks for shoulder surgery. Reg Anesth Pain Med 2017; 42:32–8 [Article] [PubMed]