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SUBSCAPULARIS PLANE BLOCK - A NOVEL PHRENIC NERVE SPARING SHOULDER BLOCK- AN ANATOMICAL STUDY TO EXAMINE THE SPREAD OF INJECTATE
ESRA Academy. Vissa D. Sep 8, 2016; 138450; 0301 Topic: Upper Limb Blocks - Brachial Plexus Block
Dr. Deepti Vissa
Dr. Deepti Vissa

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Abstract
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Background and Aims:

Though Interscalene-block is the gold standard for shoulder surgeries, ipsilateral diaphramatic paralysis invariably occurs. Distal blocks targeting Suprascapular and Axillary Nerves separately are inferior. We hypothesized that a single-injection, Phrenic-nerve sparing Subscapularis-Plane-Block would block both Axillary and Suprascapular nerves apart from other nerves supplying the joint.

Methods:

Ultrasound-guided SPB blocks were performed bilaterally on two fresh cadavers (n=4). With the linear transducer aligned in the sagittal plane, head-of-humerus was identified and transducer moved medially to identify bicipital grove, then coracoid process. Medial to it from superior to inferior, Deltoid muscle, Pecs, Subscapularis-muscle and scapular fossa were identified. A nerve block needle was inserted in-plane and superficial to Subscapularis-muscle and a volume of 2ml of dye(methylene-blue, 5% dextrose) was injected. Each cadaver was dissected to note the spread of injectate.

Results:

First of the four injections spread to posterior-cord staining the Axillary, Radial and upper branch of Subscapular nerve, and proximally spread towards the suprascapular notch. Second injection done deep to the subscapularis fascia, migrated into joint capsule and did not stain plexus. Third injection between the bicipital grove and coracoid process spread along the posterior-cord with no spread towards the suprascapular grove. Fourth injection, done from inferior end of probe, spread laterally into the plexus. There was no proximal spread of injectate into the neck, ruling out Phrenic nerve block.

Conclusions:

This is a novel Phrenic Nerve sparing, single injection Subscapularis-Plane-Block. We demonstrated a considerable spread of injectate to the posterior cord staining the Axillary nerve and possible spread to the Suprascapular nerve. 

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