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SUPERIOR TRUNK (C5/6) BRACHIAL PLEXUS BLOCK / OR PULSED RADIOFREQUENCY DENERVATION UNDER ULTRASOUND FOR CHRONIC SHOULDER PAIN MANAGEMENT-A NOVEL APPROACH WITH POSSIBLE BETTER OUTCOME
ESRA Academy. Thottungal A. Sep 8, 2016; 138583
Topic: Chronic Pain Management
Dr. Athmaja Thottungal
Dr. Athmaja Thottungal

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Abstract
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Background and Aims:

Shoulder pain is the second common MSK chronic pain problem. The aetiology is variable,but the current nerve block option is suprascapular nerve block (SSNB) which does not provide complete analgesia.Inter Scalene Block(ISB) is the gold standard for shoulder surgery.Superior trunk block using low volume local anaesthetic instead of ISB is gaining popularity to avoid the side effects.This is a pilot series finding superior trunk (C5/C6) block will be a more effective treatment option.

Methods:

5 Patients, ASA3, referred by the orthopaedic team unfit for surgery were selected. Pain score varied between 6-10 on the NRS and disability score 5-10. Two patients had bilateral shoulder problems. Age ranged 76-92 years. All 5 patients had superior trunk block  (C5/6) under ultrasound guidance and block was performed using 5-7 ml of 0.125% L-bupivacaine and 7.6 mg of dexamethasone. PRF was performed using 420C,, 45v for 6 minutes and post procedure same block was performed.

Results:

Immediately following the procedure the pain and disability scores were reduced to 0-2 and 1-3.  At 8 weeks follow up pain relief was 60-100%. Two were proceeded to PRF after 6-8 months as the pain was returning. Two patients were discharged back to community. One patient had the same procedure in the second shoulder and the pain relief of first shoulder is still continuing after 12 months.

Conclusions:

The use of ultrasound to refine the option of block to superior trunk to  maximise the effect of  pain relief  could be a superior and safer option to treat chronic shoulder pain.

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