Correspondence  |   June 2019
Supraclav Suprascap Interscalene Shoulder Surgery: Comment
Author Notes
  • Meenakshi Hospital, Thanjavur, India (V.V.). vinodhavijayakumar@gmail.com
  • (Accepted for publication March 6, 2019.)
    (Accepted for publication March 6, 2019.)×
Article Information
Correspondence
Correspondence   |   June 2019
Supraclav Suprascap Interscalene Shoulder Surgery: Comment
Anesthesiology 6 2019, Vol.130, 1085-1086. doi:10.1097/ALN.0000000000002713
Anesthesiology 6 2019, Vol.130, 1085-1086. doi:10.1097/ALN.0000000000002713
We read with great interest the noninferiority trial by Auyong et al.1  We greatly appreciate the authors for their novel technique, the anterior suprascapular nerve block. They have shown that it provides noninferior analgesia compared to that of interscalene block, and at the same time preserves vital capacity and has lower incidence of Horner syndrome.
Our question is: when the anterior suprascapular block, which did not target the superior trunk, offers a noninferior analgesia to interscalene (targeting the roots and trunks), how did the supraclavicular block targeting the superior and middle trunk not offer a noninferior analgesia? As per the authors, for supraclavicular block, a large volume of local anesthetic is required as the cross-sectional area of the brachial plexus increases at the supraclavicular level. This could have been a good explanation if the brachial plexus divisions were targeted, but the authors had targeted the superior and middle trunk in the supraclavicular group. When 15 ml volume of local anesthetic was deposited at the suprascapular nerve, laterally away from superior trunk had spread and blocked the axillary and subscapular nerves, arising from the posterior division of superior trunk (in the anterior suprascapular group), how did the same volume of local anesthetic that was deposited directly on the superior trunk (in the supraclavicular group) not block them?