Suprascapular block and PTX

[Hamhock]

---

Members don't see this ad.

So I keep reading that there is a small risk of PTX associated with suprascapular nerve blocks. I am assuming this risk was associated with older techniques and when ultrasound was not used.

Has anyone heard of an iatrogenic pneumo from an ultrasound-guided, in plane block of the suprascapular nerve at the notch using a technique like that described in the reference below?

Harmon in Pain Physician (2007) 10:743-

It doesn't really seem possible to me with this technique, but maybe I am missing something.

Thanks, HH

 

[urge]

I'm sure someone can do it.

 

[Idiopathic]

i dont know but it sounds worthy of a case report, so there you go

 

[proman]

I don't think you'll find many anesthesiologists who consider it appropriate for emergency physicians to perform regional anesthesia, with or without ultrasound. The OP has previously posted about doing a popliteal block for a plantar lac, which I consider to be an inappropriate use of a peripheral nerve block performed by an inadequately trained physician. Anesthesiology residents do hundreds of PNBs before being credentialed, I know EM residents don't get anywhere near that experience. Am I the only one thinking this?

 

[nap$ter]

I don't think you'll find many anesthesiologists who consider it appropriate for emergency physicians to perform regional anesthesia, with or without ultrasound. The OP has previously posted about doing a popliteal block for a plantar lac, which I consider to be an inappropriate use of a peripheral nerve block performed by an inadequately trained physician. Anesthesiology residents do hundreds of PNBs before being credentialed, I know EM residents don't get anywhere near that experience. Am I the only one thinking this?

i was thinking that, and that the OP should do his own literature search, but didn't know a nice way to say it...

 

[Hamhock]

i was thinking that, and that the OP should do his own literature search, but didn't know a nice way to say it...

Yes, I have done a literature search and hadn't found any reports of pneumo using this technique.

However:

1. I am not sure that someone would necessarily publish such a case report.

2. Anesthesiologists, as noted above, do way more blocks than EM docs...just by numbers (even if it is assumed anesthesiologists are 1000x more competent at this), I suspect an anesthesiologist is more likely to have heard of such a complication (vs. an EM doc).

Thanks, HH

 

[BLADEMDA]

http://www.ncbi.nlm.nih.gov/pubmed/20508135


Sometimes you can lose track of the needle tip. Combine that fact with a small bleb (COPD) and pneumothorax is possible. The corner pocket technique puts the tip of the needle very close to the first rib. It wouldn't take much needle advancement to get near the pleura (yes your needle would be off target).

 

[BLADEMDA]

http://www.ncbi.nlm.nih.gov/pubmed/20607905


To the OP please click on the above link. Another "risk" to doing this block is nerve injury.

 

[Arch Guillotti]

http://www.ncbi.nlm.nih.gov/pubmed/20508135


Sometimes you can lose track of the needle tip. Combine that fact with a small bleb (COPD) and pneumothorax is possible. The corner pocket technique puts the tip of the needle very close to the first rib. It wouldn't take much needle advancement to get near the pleura (yes your needle would be off target).

OP is talking about doing a suprascapular block.

 

[Hamhock]

OP is talking about doing a suprascapular block.

Yes, thanks for the links Blade, but I was actually talking about supraSCAPular not supraCLAVicular; where, even with good U/S technique, PTX seems possible.

vs. supraSCAPular, where I can't see it happening, but PTX is always listed as a potential complication...I am really guessing it is based on old suprascapular techniques.

HH

 

[Idiopathic]

a good corollary to this is that pneumothorax is a possible complication of ANY PROCEDURE DONE POORLY

 

[imfrankie]

So I keep reading that there is a small risk of PTX associated with suprascapular nerve blocks. I am assuming this risk was associated with older techniques and when ultrasound was not used.

Has anyone heard of an iatrogenic pneumo from an ultrasound-guided, in plane block of the suprascapular nerve at the notch using a technique like that described in the reference below?

Harmon in Pain Physician (2007) 10:743-

It doesn't really seem possible to me with this technique, but maybe I am missing something.

Thanks, HH

This summer's issue of Regional Anesthesia and Pain Medicine had a review article on the suprascapular nerve block. There is a page in the article with numerous references.

No need to go for the notch, just get under the supraspinatus fascia on the floor of the scapular spine. Aspirate though--artery in the AO.

Anybody doing these with ISC for (awake) shoulders?

 

[IN2B8R]

a good corollary to this is that pneumothorax is a possible complication of ANY PROCEDURE DONE POORLY

👍