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Correspondence  |   August 2018
In Reply
Author Notes
  • University of Ottawa, Ontario, Canada (F.W.A.). FAbdallah@toh.ca
  • (Accepted for publication May 1, 2018.)
    (Accepted for publication May 1, 2018.)×
Article Information
Correspondence
Correspondence   |   August 2018
In Reply
Anesthesiology 8 2018, Vol.129, 380-381. doi:10.1097/ALN.0000000000002278
Anesthesiology 8 2018, Vol.129, 380-381. doi:10.1097/ALN.0000000000002278
We thank Dr. Musso et al. for the comments on our recently published paper.1  They correctly point out that the shoulder joint innervation is not limited to the suprascapular nerve. While we agree with this statement, it seems that the contribution of other nerves is modest as compared to the suprascapular nerve. Indeed, the suprascapular block does not provide a full sensory block; however, when it comes to postoperative analgesia, the differences we observed between suprascapular and interscalene blocks were not clinically important. This suggests that the use of multimodal analgesia is sufficient to mitigate any difference in analgesic efficacy between the two blocks.
We also thank Dr. Brotman et al. for their comments. Our work1  demonstrated the utility of suprascapular block as an analgesic alternative to interscalene block for shoulder surgery. It is clear that we did not propose a swift transition to suprascapular block as a new care standard for shoulder surgery. Interscalene block, by virtue of its blockade of the brachial plexus at the level of the roots, continues to be the care standard. With some adjustments to the dose, injectate distribution, and intraoperative sedation level, the interscalene block can provide adequate surgical anesthesia. However, this does not dismiss the ability of interscalene block alternatives to provide surgical anesthesia. In cases where it is desirable to avoid both general anesthesia and phrenic nerve block, and when the number of injections is not a barrier, determined regional anesthesiologists may wish to consider either a combination of (1) suprascapular and infraclavicular blocks,2  or (2) suprascapular, axillary, supraclavicular, and the lateral pectoral nerve blocks,3  in order to achieve surgical anesthesia. In our clinical experience, these combinations can provide reliable surgical anesthesia, if needed.
Research Support
Supported by research time support from the Department of Anesthesiology and Pain Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada (to Dr. Abdallah).
Competing Interests
The authors declare no competing interests.
Nasir Hussain, M.Sc., M.D., Faraj W. Abdallah, M.D. University of Ottawa, Ontario, Canada (F.W.A.). FAbdallah@toh.ca
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]
Bansal, V, Shastri, U, Canlas, C, Gadsden, JC Diaphragm-sparing nerve blocks for shoulder surgery: An alternative approach. Reg Anesth Pain Med 2017; 42:544–5 [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]